When to Start Transition Care in Children with Type 1 Diabetes

What's the right age for children to start taking the lead in managing their diabetes?

Preparing your child to manage his or her diabetes entails adding responsibility with each passing year. When thinking about transitioning your child with type 1 diabetes—which ultimately means independence regarding their diabetes self-management (going from a pediatric doctor to an adult doctor is called TRANSFER) —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.

Start the Process Early for Best Results

While previous recommendations have suggested that preparation for transition and transfer to an adult provider should occur at least one year prior to going away to college, this may not be realistic. You don’t want to be coming up on the end of summer before your child goes away to school 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 appointments with their health care provider. 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 can also be helpful that your adolescent meet with their healthcare4 provider alone for part of an office visit. This allows for an open exchange of honest questions and answers, but also helps them get comfortable meeting with their healthcare team alone.

It is also important that your child answers questions from the healthcare professionals at each appointment. While is very difficult as a parent to not want to answer for your child, it is crucial that they respond to the requests of the healthcare team.

Time alone with the healthcare provider leaves them no choice but to answer the questions for themselves. If it's most helpful for you to be in the room, allow them to attempt to answer the questions first, before jumping in. The goal should be working with the healthcare professionals at each visit and to have a few “goals toward independence” in mind.

What an 8-Year-Old Can Do

Here, a few examples of what may be appropriate for a second or third grader:

  • Work on giving herself injections by her next birthday (age 9) 
  • Counting all their carbs (with some coaching from you or your spouse) and doing the basic calculations for how much insulin to take
  • Knowing which type and how much insulin they use, and reporting about that at every visit.

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

Find an Endocrinologist Sooner Rather than Later

Another “good to start early" step is locating an adult endocrinologist. It may take awhile to “click” with a new doctor, and it's best to allow plenty of time for the search process as endocrinologist aren't readily available in many parts of the country. While many pediatric endocrinologists will tend to continue to see patients until that age of 18—or even through college—some adult endocrinologists are comfortable working with adolescents age 14 or older.  

Talk to your child’s pediatric endocrinologist about who he or she recommends in your area, and then set up an appointment. Think of the first visit 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 transfer from the pediatrician to a primary care doctor. It’s a good idea to start that search process early as well. Be sure to have an honest discussion with your current healthcare provider to understand expectations—can your adolescent remain in their care until after they finish their undergraduate degree? Or do they expect transfer of care to occur before college starts? Gaining clarity to these important milestones will also help guide the trajectory of transition.

Assessing Readiness

There are several ways to gauge “readiness” in order to identify WHEN children and adolescents can actually manage these milestones and age-related responsibilities. An easy guide can be found by visiting the Got Transition website. This resource provides a comprehensive set of details to consider to help you gauge what your child can and cannot do and what age-related responsibilities need to be worked on.

No Matter What Age: Keep Talking

One of the best things you can do for your child in this transition is to keep the conversation going. This is a process, not a one and done. Let her know that you are here to support her and help her make good decisions—but that she will have to slowly learn to manage more of her care on her own.

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.

Updated on: September 6, 2019
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