Making the Leap From Type 1 Teen to Adult

Help teens learn how to balance their new independence with diabetes self-care.

Teens face lots of new challenges after they finish high school and move on to the next stage of life, including how to manage money, college, relationships, and work. And if they’re moving away from home for the first time, they’ll face those challenges with less help from parents and less structure in their day. This has even more impact for teens with diabetes.

Parents usually had the main role in diabetes care at first, especially for young children. They took their child to doctor’s appointments, picked up medicines, and provided nutritious food. They helped their child navigate school, after-school activities, birthday parties, and other social events.

It’s only natural that teens on their way to becoming adults want more independence and control. But more control over their lives can often mean less control of their diabetes. No curfew, no comments on what they’re eating, no one else setting their schedule. Diabetes care often suffers when teens and young adults begin to make complicated decisions on their own:

• Managing day to day, from eating well to taking insulin
• Finding health care providers
• Scheduling and keeping appointments
• Having supplies on hand

Young people need help to successfully balance their new independence with diabetes self-care. They’ll need to know how to deal with the practical side of diabetes: how to fill a prescription and pay for it, order supplies, contact their doctors, make health care appointments, and handle sick days. And they’ll also have the everyday problems that come with life on their own:

• Limited time
• Limited money
• Irregular schedules
• Food choices
• Concerns about low blood sugar (hypoglycemia), which can lead to overeating
• Less support

They may also be tired of the daily work of having diabetes and decide to ignore it. This can be very dangerous, especially when parents aren’t there to notice.

Gap in Care

Teens also need to make the leap from seeing a pediatrician to seeing an adult health care provider, usually without a clear road map for how to do so. When several changes happen at the same time, like getting new doctors and moving away from home, young people are more likely to miss appointments or drop out of care completely.

Other barriers can make it harder for teens and young adults to switch to adult health care:

• Being unhappy about leaving their pediatrician
• Getting a referral and contact information for a new doctor
• Trouble getting an appointment
• Competing life priorities
• Having insurance problems

But good care during this time is very important. Teens and young adults with diabetes have a much higher risk of early health problems, even early death, than those without diabetes. Major causes include hypoglycemia (low blood sugar) and diabetic ketoacidosis (DKA).

Staying close to recommended blood sugar goals helps them avoid these health problems and others down the road. But as teens and young adults with diabetes transition from pediatric to adult care, the risk of not meeting those goals more than doubles.

Get Ready To Make the Leap

Help teens get prepared to manage their diabetes care successfully before they’re out on their own. Parents, teen, and pediatrician can work together to coordinate care with new doctors and create a plan to address needs over the next year or two. Parents can share practical tips, such as how to fill prescriptions and make doctor’s appointments. They can also make sure their teen or young adult has this basic checklist before they leave home:

• Keep supplies on hand to manage low blood sugar (and healthy snacks to guard against high blood sugar).
• Keep supplies organized so you know what you have and can get to them easily.
• Keep contact information for your health care team and prescription information in a handy place.
• Tell people close to you that you have diabetes and how to help you if needed.
• Have a plan for sick days.
• Ask for help if you need it.
• Stay in touch with your health care team and let them know if you have questions or concerns.

Bridge the Gap

Family support is the strongest predictor that teens and young adults will stick with their diabetes treatment plan. Parents can serve as the “home team” to help them stay on track as they become more self-reliant by:

• Respecting their new independence, but staying connected. Ask how you can help.
• Helping your teen understand how their insurance plan works as well as its benefits and limitations.
• Reminding teens about short-term benefits of managing their diabetes, not just focusing on long-term health problems. They’re more motivated to take care of themselves if it helps them feel better physically and take part in normal activities with their friends.
• Asking about any life issues that may be getting in the way of good self-care, such as trouble making and keeping doctor’s appointments.
• Encouraging your teen to ask their health care provider for a referral to diabetes self-management education and support (DSMES) services. Diabetes education is strongly linked to better blood sugar management!