Influences

It’s only natural that teenagers on their way to becoming adults want more independence and control. But more control over their lives can often mean less control over their diabetes. No curfew, no comments on what they eat, no one else setting their schedule.

Diabetes care often suffers when teens and young adults start making decisions on their own:

• Manage day to day, from eating well to taking insulin
• Finding health care providers
• Planning and compliance with agreements
• Have supplies on hand

Young people need to know how to deal with the practical side of diabetes. This includes how to fill a prescription, order supplies, contact their doctors, make medical appointments and handle sick days. And they will also have the daily problems that come with living alone:

• Limited time
• Limited money
• Irregular schedules
• Food choices
• Concerns about low blood sugar (hypoglycemia)
• Less support

They may also be tired of the daily grind of having diabetes and decide to ignore it (also known as diabetes emergency). This can be very dangerous, especially when the parents are not there to notice.

Gaps in care

Teens will also stop seeing a pediatrician and start seeing an adult health nurse. But they usually don’t have a clear road map of how to do it. There are often several changes at the same time, such as getting new doctors and moving away from home. When this happens, young people are more likely to miss appointments or drop out of care altogether.

Other barriers can make it harder for teenagers to transition into adult care:

• Being unhappy about leaving their pediatrician
• Get a referral and contact information for a new doctor
• Problems getting an appointment
• Competing life priorities
• Have insurance problems

But good care during this time is very important. Young people with diabetes have a much higher risk of early health problems, even early death, than those without diabetes. Main causes include hypoglycaemia (low blood sugar) and diabetic ketoacidosis (DKA).

Staying close to recommended blood sugar targets helps them avoid these health problems and others. But as teens with diabetes transition from pediatric to adult care, the risk of not reaching these goals more than doubles.

Best practice

Help teens prepare to successfully manage their diabetes care before they’re out on their own. Parents, teens, and pediatricians can work with new doctors to create a plan to meet needs over the next few years. Parents can share practical tips, such as how to fill prescriptions and make doctor appointments. They can also make sure their teen or young adult has this basic checklist before they leave home:

• Keep supplies on hand to manage low blood sugar (and healthy snacks to prevent high blood sugar).
• Keep supplies organized and easy to access.
• Keep contact information for your healthcare professional and prescription information handy.
• Tell people close to you that you have diabetes and how to help you if needed.
• Have a plan for sick days.
• Ask for help if you need it.
• Stay in touch with your health care professional and let them know if you have any questions or concerns.

How you can help

Family support is the strongest predictor of teens and young adults sticking with their diabetes treatment plan. Parents can act as the “home team” to help them stay on track as they become more self-reliant by:

• Respects their new independence but remains connected. Ask how you can help.
• Help your teen understand how their insurance plan works.
• Remind teens of the short-term benefits of managing their diabetes, not just the long-term health problems.
• Ask about problems that may prevent good self-care, such as making doctor’s appointments.
• Encourage your teen to ask their doctor for a referral education and support for diabetes self-management.

Diabetes education is strongly associated with better blood sugar control!