Diabetes Self-Management Articles

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Transitioning to Adult Care

by Jean Roemer, MSN, MN, CPNP, CDE

In addition to looking for a physician for your college student, find out whether there are any young adult support groups or programs for students with diabetes at the school. The Web site of the school your child will be attending may list student groups and activities, and it should have contact information for staff in charge of various aspects of student life, including clubs and organizations.

Help your child explore transportation options in the area he’ll be living to determine how easily he’ll be able to get to medical appointments.

Talk about problem solving, and strategize what to do when situations come up. Part of maturity is anticipating and preventing problems. You can role-play these situations, which is a great rehearsal for the real thing. If you and/or your child are not sure what to do in the following situations, thinking about it now gives you the chance to talk to his pediatric providers or otherwise research possible solutions.

• What will you do when you’re sick or you wake up with large ketones because your pump pulled off in the night?

• What will you do when you run out of insulin at 11 PM?

• What will you do when encouraged by your friends to smoke, chew, drink alcohol, take drugs, or have sex?

• What will you do if you feel really low in the middle of the night and your roommate is sleeping or not in the room? How will you deal with low blood glucose at night?

• What will you do if you find out an exam is scheduled for the day of your next diabetes appointment?

• What will you do if you develop a blister or cut on your foot that won’t heal, is painful, or looks infected?

• What will you do if you notice your vision is blurry?

Talk about targets, goals, and priorities, and encourage your young adult to talk to his diabetes provider about these so that they are achievable, understood, and accepted.

Of all the tasks and goals involved with diabetes management, the most important is that the person with diabetes takes all of his insulin all of the time. When blood glucose control deteriorates rapidly, it is most often because insulin has been omitted. Talk to your child with diabetes about this fact, stay informed about his insulin dosing, and remind him of the importance of taking all of his prescribed insulin as necessary.

Parents should begin to allow their teen or young adult to be seen alone during medical appointments at least six to nine months prior to transitioning to adult care. It is hard not to be as involved, but encouraging your child to take ownership of his diabetes is key. Even though you may still be legally responsible for your teen, give him a chance to do it on his own. Most health-care providers will encourage this and can give you a summary at the end of visits.

When looking for a provider of adult diabetes care, look for one who sees a lot of young adults and appears to have a good working relationship with them. Some multidisciplinary programs (those that have staff from many professional disciplines, such as nutrition, psychology, and weight loss, in addition to medicine and nursing) are evolving at larger centers that are focusing on introducing the adult provider while the teen or young adult is still being seen in the pediatric setting.

Look for a provider who has access to diabetes educators, dietitians, and social services and who has a research focus. Ask if the practice is involved in any research studies; often, when a person participates in a research study, some services are covered financially. Large programs are most often found at university settings, and if your young adult is lucky enough to be near one, take advantage of it.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.



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