After High School (Parents)
Your child is heading off to college or starting a new job or training program. You’ve been working towards this for 18 years, but you’re understandably full of emotion -- not to mention worry, because your child is living with type 1 diabetes. Here at the U-M Pediatric Diabetes Clinic, we want you to know now is a time to celebrate, not worry! We know you have questions, and we want to help guide you to answers and resources to help you and your child prepare for this new and exciting transition in their life.
If they have not already, it may help your teen to read through After High School (Teens).
Much of the following information can be found in The Diabetes Link’s “Off to College: Caregiver Guide” which can be viewed online here.
A Time to Explore
Your child is going to be making a lot of decisions on their own now -- and not all of those decisions will be good ones. College may be the first time they are responsible for feeding themselves, and that pizza buffet probably looks tempting. Not to mention their crazy schedules, late night study sessions, and sporadic naps after morning classes. Instead of getting frustrated, try to help them through this transition period. Offer to stock their room with healthy snacks so they don’t rely on junk food to make it through the day. Work with them to find a balance in their schedule so they know how to fit in diabetes care during busy days. Ask them what you can do to help from afar, and don’t be afraid to give them independence if they seem ready for the challenge. Remember, you’re still their parent and their primary reference point for when things get tough -- they may still need you to explain to them what the heck their insurance coverage even means.
Make a Plan
Your child may feel like you’re hovering too much, while you may feel like their diabetes care is getting out of control. Both sides should take a breather, remember that T1D is a team effort, and make a plan to communicate effectively. For example, how often will your child check in? How often will you discuss blood sugars together? Who will be responsible for scheduling diabetes appointments? Your child can make you promises, like wearing a medical alert ID bracelet on campus, in exchange for your promises, like not starting phone conversations by talking about diabetes.
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Your role as a parent and caregiver can also be to fill in gaps in your child’s T1D management. For example, make sure they have a sick day kit in case they catch a cold on campus. Look for special accomodations through the school through Disability Services (sometimes called Student Support, Auxiliary Services, etc.) Help them find their pharmacy and be sure they have enough supplies for move-in. Send a care package that isn’t diabetes-specific, but includes things like low snacks or their favorite candy.
Avoid the Burnout
This time in your child’s life can be extremely stressful, especially with diabetes. As a result, they may feel sick of their diabetes, commonly referred to as ‘burnout’. This can manifest in different ways -- maybe they stop rotating their pump sites, or leave their meter in their dorm room in an attempt to forget the diabetes even exists. This does not mean they are being lazy or negligent to their health. Try to acknowledge their burden and help them as much as you can without nagging or pressuring them in a way that feels judgmental. These feelings are very common and will likely happen at some point. Remind them that they are doing their best and celebrate their successes. Encourage them to talk to peers, professionals, or seek out mental health resources if they are experiencing depression or anxiety.
Alcohol and Relationships
As your child gets older, the likelihood of them drinking and dating will increase, and college is an especially common time for them to experiment with these new aspects of their life. Talk to your child about safe sex and drinking. If this is uncomfortable for you, just remember that these are potentially life-saving practices to keep in mind. You can also communicate to your child’s care team that they need this information. More information on these topics can be found in The Diabetes Link’s Off to College Caregiver Guide, which is available online here.
Check out Beyond Type 1 for various real-world examples of dating with T1D you may find helpful to share with your teen.
Transitioning Care
While they will always be your baby, the time has come that your child is grown and will soon transition to an adult endocrinologist for care. While there is no set time for this change, it typically occurs when your child is between 18-21 years old. We recognize that adding another transition on at the time your child goes to college can be too much for most teens, and we are glad to see you through this transition and continue to support your management efforts.
One thing you may want to consider - there are many more adult endocrinologists than pediatric endocrinologists and it may make care more convenient for you to transition to a local provider if distance is a barrier to follow up with our team. You can reach out to us with any concerns about transitioning care or read more about our Clinical Programs here.
Insurance
Your child remains eligible for secondary (or tertiary) insurance coverage through Children’s Special Healthcare Services (CSHCS) through the state of MI until age 26. In short, this picks up the out-of-pocket costs related to all diabetes care, medications and supplies (with some exceptions).
If your child is already enrolled, the only change at age 18 will be the premium/fee, which will be based on the child’s income independent of the parent/household - even if the child is still a dependent, living at home, attending school, etc.
If your child is not already enrolled (typically because your family income is greater than the premium that you would pay for CSHCS coverage), reach out to your team social workers to discuss possible enrollment, as the program often benefits our patients who are 18-26 years of age.
NOTE: CSHCS is a state program, which means that, if your child attends college out of state, CSHCS cannot be billed where they attend school. In this case, make a plan with your child for how you will fill prescriptions in MI and get them to your child at school - you can contact us for details of how to make this process easier.