There comes a time when the teenager with diabetes needs to link up with a team experienced in the care of adults.
This transition can be quite emotional and stressful for all. Moving on to a new health care setting is like graduating from high school to college. Over a short period of time, the teenager shifts from being the biggest, oldest, and wisest person to being a young, inexperienced rookie in a larger and different environment. Some find the experience exciting. Others prefer the security of the old setting. What the treatment team expects of your teen in self-management and control is different between paediatric and adult care. In the adult system, young adults are expected to gradually take complete responsibility for themselves.
As teenagers enter the adult system, many are surprised by the demands placed on them. If they are not already doing so, they may be expected to practise more intensive management of their diabetes, aiming for tighter blood sugar control through more frequent injections and glucose monitoring. There will be changes in meal plans, as they are no longer growing. Some find they are not as physically active as they used to be, and have to make up for that with a more structured exercise regimen. As their risk of complications increases with age, they may have to monitor blood pressure and see an eye doctor more frequently. Routine foot care will be emphasized to prevent infections and identify signs of nerve damage.
These demands can be overwhelming. The newly graduated teenager might feel he can’t meet them. Some young adults are tempted to drop out of care altogether. The support system of family and friends throughout this transition phase is vital to ensure that the young adult continues with the care needed to manage his diabetes.
When to make the change
Ideally, the change to adult care should come when your teenager is confident and responsible enough to move forward. Hospital or clinic policy usually dictates a transition between the ages of 16 and 20. You and your teenager should be aware of this well ahead of time in order to prepare.
You can help your teen make a successful transfer by encouraging him to take an active part in his diabetes care as a child and into adolescence. Encourage him to solve problems and make choices about adjusting insulin doses, for example. This sets the foundation for your child to manage his own behaviour in adulthood, which is essential. Teenagers also need private time with all members of the diabetes team. This promotes their independence and responsibility. Before they move into adult care, teens should have the opportunity to explore various options for continuing their diabetes health care. Also, a referral should be made to the adult team. It is also helpful for a teen leaving the paediatric centre to take part in either an individual or group program. The program should stress the need for excellent ongoing blood glucose control, surveillance for complications, and changing expectations.