When to Start Transition Care in Type 1 Diabetes
In thinking about transitioning your child with type 1 diabetes from a pediatric doctor to an adult doctor, you may be wondering: when should this process start?
As with many developmental questions, the answer isn’t entirely straightforward, unfortunately! The answer comes down to this: when your child is ready, you can start thinking about transition.
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.
There are, however, 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 they aren’t prepared. It is best to start earlier rather than later in getting your child ready for handling diabetes on their own.
When you think your child is developmentally ready, start allowing him or her to, for example, 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 they learn early to take an active role in their care, it won’t be as intimidating later on.
It is also important that your child answers questions posed by the healthcare professionals at each appointment as well as working with the healthcare professionals to have “goals toward independence” at each visit.
For example, for an 8-year-old:
- having them give their own injections by their birthday
- having them count up all their carbs and doing the calculations of how much insulin to take, with the help of mom or dad
- knowing which insulins they use and the doses and reporting that at every visit.
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 to self-care is to keep talking. Let them know that you are here to support them and help them make good decisions, but ultimately, they will have to take care of themselves.
Letting go of some of the control over your child’s care may be difficult. You’re so used to taking care of them, but even in the midst of that, you’re training them to take care of themselves. Learning to trust them in their diabetes care may actually be a challenge, but remember: you want what’s best for them, and by teaching them to take care of themselves, you are doing what’s best.