When to Start Transition Care in Type 1 Diabetes

Written by Amy Hess Fischl, MS, RD, LDN, BC-ADM, CDE

In thinking about transitioning your child with type 1 diabetes—which ultimately entails going from a pediatric doctor to an adult doctor—you may be wondering "When should this process start?"

As with many developmental questions, unfortunately, the response isn’t entirely straightforward! The answer comes down to this: You are most aware of your child’s maturity and ability to handle responsibility. Just as you do with other decisions about how much he or she can handle, you will be the best judge for timing.

However, there are some general guidelines about when to begin transition care, and what should be considered at various stages.

Early Is Best

You don’t want to be coming up on the end of summer before your child goes away to college for the first time—and realize that he isn't prepared. It's best to start earlier rather than later in getting your child ready for handling diabetes on her own.

When you think your child is developmentally ready, one thing you might try is allowing her to decide how much insulin to bolus for a meal. You may have always done this in the past, but giving your child the opportunity to grow in confidence in making these decisions is important.

Starting early, you can also encourage your child to ask questions during doctor’s appointments. Help them understand that one day, you won’t be there to ask questions and interpret information; if your child learns early to take an active role in her care, it won’t be as intimidating later on.

It is also important that your child answers questions from the healthcare professionals at each appointment. The goal should be working with the healthcare professionals at each visit to have “goals toward independence.”

A few examples of what may be appropriate for an 8-year-old:

Even small steps like these can give your child a leg up in making a smooth transition to self-care.

Another “good to start early step” is finding an adult endocrinologist. It may take awhile to “click” with a new doctor, and you want to allow plenty of time for the search process.

Talk to your child’s pediatric endocrinologist about who he or she recommends in your area, and then set up an appointment—although you may want to think of it as an “interview.”  In that time, you and your child can gauge the doctor’s approach to diabetes care and see if it aligns with your own.

Of course, your child will also have to transition from the pediatrician to a primary care doctor. It’s a good idea to start that search process early as well.

No Matter What Age: Keep Talking

One of the best things you can do for your child in this transition is to keep talking. Let her know that you are here to support her and help her to make good decisions—but that she will have to slowly learn to manage more of her care herself.

Letting go of some of the control over your child’s care may be difficult. But remember that you’re teaching and empowering your chlid to take care of herself. Learning to trust your child in her diabetes self-care may actually be a challenge. Ultimately, you want what’s best for your son or daughter. Encouraging her to be independent with managing her diabetes is one of the best gifts you can give your child.

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