What Is Transition Care in Type 1 Diabetes?

How to Plan Ahead for the Transition from Pediatric to Adult Diabetes Care

Empower your child as he becomes more independent with his diabetes care.Transition care: If your child was diagnosed with type 1 diabetes when he or she was young, at some point, you'll encounter this phrase.

From the time your child was diagnosed, you’ve been, most likely, dealing with a pediatric endocrinologist and a diabetes treatment team. But there will, of course, come a time when your child can no longer see the pediatric endocrinologist; he or she will need to transition to an adult endocrinologist and an adult treatment team.

This is the crux of transition care: helping your child make the jump to taking care of their diabetes treatment on their own.

As a parent, you know that that’s a big part of raising kids—getting them ready to thrive in the world. When you add in the transition to managing diabetes on their own, it can be a frightening proposition (for you and for them).

However, we know that you want what’s best for your child with type 1 diabetes, and that’s why we’ve created this series addressing transition care. It will help both of you make this important transition.

Why Is a Good Transition So Important in Type 1 Diabetes?

We probably don’t even have to mention this: type 1 diabetes is a chronic, lifelong condition, and your child (and the rest of your family) has had to learn how to live with it.

Blood glucose monitoring, insulin doses, hypoglycemia, sick day management, bolus and basal, pump therapy.  All these phrases—and more—have become part of your daily vocabulary.

You’ve managed doctor’s appointments, nighttime hypoglycemia, and making sure you have enough supplies before heading out on vacation. You have, in short, been an integral part in managing your child’s diabetes.

But just as they must learn to handle other aspects of their life on their own—growing in responsibility as they grow older—children with type 1 diabetes will need to learn to handle their diabetes on their own.

If this transition from pediatric to adult care in diabetes (and from you managing more of your child’s day-to-day diabetes need to them self-managing) isn’t handled well, it can have long-term consequences.

If your child has been diagnosed with diabetes for over 10 to 15 years and blood glucose levels have not been in the recommended range for the majority of that time, early signs of diabetes complications (such as heart disease and eye trouble) can start to show up in that late teenage to mid-20s phase, so maintaining good control is especially vital.

A big part of maintaining good control is regularly seeing the doctor and/or the diabetes treatment team. If there isn’t a smooth transition between pediatric and adult care, months—or even a year or more—can go by without an appointment, potentially leading to worse control.

Also, if your child can create healthy, structured diabetes behaviors during that “early adulthood” phase—commitment to self-monitoring, paying attention to their meals, exercising, etc.—then he or she is more likely to stick with these behaviors for years to come.

Your Current Diabetes Treatment Team

Your best resource in transition care is going to be your pediatric endocrinologist and your current diabetes treatment team. Get them on board early with helping you and your child make a successful transition. For instance, they will be able to recommend an adult endocrinologist (or a primary care doctor with a lot of diabetes experience, if you do not have an adult endocrinologist in your area).

Also, your diabetes treatment team will be able to work with you in getting your child to take a more active role in his or her care. The doctor can, for instance, start addressing more questions to your child (than to you) during appointments. Even something as small as asking, “How have your levels been?” can be empowering for your child  Some key concepts and age ranges that they should be discussed are included below:

Ages 8–10:

Knowledge:

  • Begin to answer questions in clinic
  • Why you need to attend clinic every 3 months
  • The importance of A1C values and target goals
  • What it means to have diabetes
  • Why some people have diabetes and others do not
  • Importance of testing blood sugar and learning to test blood glucose (if not already)
  • How the body uses food
  • How to make healthy food choices using MyPlate  (USDA; http://www.choosemyplate.gov)
  • The causes and symptoms of hypoglycemia and its treatment
  • The role of insulin during sick-day management
  • The effect of the school day and scheduling on blood sugar levels
  • How sports, outside play, and other types of physical activity affect blood sugar levels and insulin doses
  • Role of diabetes distress on diabetes care (continue at every visit until transition)—at this age, “it is not your fault, it is ok to be mad, sad, etc)

Self-Management:

  • How to administer insulin (if not already)
  • How to check blood sugar (if not already)
  • Identify carbohydrates
  • Identification of insulin types

Ages 11–12:

Knowledge:

  • Define healthy eating and how it fits into your meal plan. Discuss ways to make healthy choices at school, when eating out with friends, and at other special occasions. Also discuss how to incorporate “occasional” foods.
  • Begin to understand how an illness like a cold or the flu can affect your body and blood sugar
  • What are urine or blood ketones, what do they signify, and how to test for them (moved from 13-15 yo)
  • How sports (especially practices versus games), play, and other exercise (including gym class) affect your blood sugar levels and insulin doses
  • How diabetes affects your school day
  • Role of diabetes distress on diabetes care
  • Self-Management:
  • Name insulin types taken, their actions, reasons for taking them, and the proper doses
  • Assume responsibility to check blood sugars on your own at specific times of the day

Adolescent Health:

  • Introduction to drinking, smoking, peer pressure, and diabetes (to continue at every visit until transition)
  • Effects of growth, puberty, and sexual development on diabetes

Ages 13–15:

Knowledge:

  • The significance of A1C, how the choices you make affect it, and how you can change it
  • Discuss the blood tests that are completed each year and why
  • Role of diabetes distress on diabetes care
  • Screen for depression

Self-Management:

  • Answer questions independently in clinic and meet alone with the certified diabetes educator for part of the visit
  • Inject insulin/change insulin pump with minimal reminders
  • Parents review blood sugar logs and help you think through and double-check insulin doses
  • Let parents know when you need medications or supplies

Adolescent Health:

  • Effects of growth, puberty and sexual development, sexual activity, and reproduction on diabetes (continue at every visit until transition)
  • Introduce concept of confidentiality between patient, parent, and provider
  • Females only: discuss impact of menstrual cycles on diabetes
  • ALL: Understand reproductive choices and the impact on your diabetes and overall health.  Discuss contraception options. 
  • The impact of diabetes on driving and the importance of checking blood sugar levels prior to driving

Ages 16–17:

Knowledge:

  • The impact of college, work, and career choices on diabetes management
  • Role of diabetes distress on diabetes care
  • Screen for depression

Self-Management:

  • Independent with monitoring and recording blood sugars
  • Independent with all insulin doses without parents reminding you
  • Begin to call/e-mail the diabetes team and speak directly with staff if there are changes in your health
  • Know health history including major illnesses, surgeries, allergies, and healthcare providers (dentist, eye doctor, psychologist)

Adolescent Health:

  • The impact of diabetes on driving, the importance of checking blood sugar levels prior to driving, and steps to take if blood sugar is low prior to getting behind the
  • Wheel
  • Females only: discuss impact of menstrual cycles on diabetes
  • Understand reproductive choices and the impact on your diabetes and overall health. 
  • Discuss effect of smoking, drugs, and alcohol on diabetes

Ages 18–21:

Knowledge:

  • Discuss long-term complications of diabetes, the need for routine follow-up and tests, and the importance of glucose control into adulthood
  • Role of diabetes distress on diabetes care 
  • Screen for depression

Self-Management:

  • Routinely call the diabetes team and speak directly with staff if there are changes in your health
  • Call for all medical refills on own and understand co-pay cost of medications and supplies

Adolescent Health:

  • The impact of diabetes on driving, the importance of checking blood sugar levels prior to driving, and steps to take if blood sugar is low prior to getting behind the
  • Wheel
  • Females only: discuss impact of menstrual cycles on diabetes
  • Understand reproductive choices and the impact on your diabetes and overall health.  Discuss contraception options. 
  • Discuss effect of smoking, drugs, and alcohol on diabetes

Socioeconomic:

 

Updated on: August 15, 2019
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When to Start Transition Care in Children with Type 1 Diabetes
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