Managing Diabetes as a Young Adult: Key Topics

• Many young adults start feeling a little out of place at a children’s hospital, and your pediatric team members are experts in managing diabetes in babies, children and teens. An adult team is better able to guide young adults, like you, in managing diabetes, and we want to make sure you get the best care possible.
• Most pediatric diabetes programs refer patients to other subspecialists who have problems associated with diabetes like high blood pressure, urine microalbumin or high cholesterol. In a pediatric setting like CHOP, you will have to make multiple appointments with different specialists to treat these problems. In contrast, most adult diabetes programs can evaluate and treat problems associated with diabetes directly — which makes it simpler, because all your diabetes-related problems can be treated in one place. 
• There are more choices for adult diabetes care. You may also have more options closer to your home or college. Your social worker will give you a list of adult providers to help you explore your options.

Between the ages of 18 to 19, most young adults transition to adult providers. We realize the year after high school graduation involves many new challenges. You may be starting a job or going to college. To make things as easy as possible, you can continue to receive care from your CHOP diabetes team for up to 12 months after high school graduation. During these 12 months, we will work with you to make sure you’re ready to transfer to an adult team.

If you’re ready to transition earlier, we can start this process sooner — especially if you’re going away to college or have to travel a long distance to attend your CHOP diabetes appointments.

• Do they take my insurance?
• Convenience — how easy is it for me to get to appointments?
• Reputation and expertise in type 1 diabetes
  • You might ask for recommendations from other adults with diabetes
  • Check out their website to find out more about them
  • Read patient reviews on other reputable websites
• Is there someone available to answer questions between appointments?
• Whom do I contact if I have problems overnight or on the weekend?
• Do many of their patients use diabetes technology (such as, insulin pumps or continuous glucose monitors)?
• What other services do they offer?
  • Do they offer diabetes education, nutrition and social work support?

Learn about making an appointment with the Diabetes Center.

You will need to complete a HIPAA form, which gives CHOP permission to share medical information. This will allow us to share information directly with your new diabetes team. We will send them a summary of your current diabetes program, recent labs and information about your other health conditions. Your social worker can help you if you have any questions.

It may be helpful to write down your questions ahead of time and have a list of your treatment-related information as well. You should bring:

• A copy of the last letter or discharge summary from your pediatric diabetes provider
• A list of all your medications:
  • Write down your insulin doses, including your basal dose (injection or pump basal rates)
  • Know your carb coverage
  • Know your correction doses
  • Write down the names and doses of any other medications you take (such as syringe size, type, meter type and strips) and including medicines you take for non-diabetes conditions
• The address and phone number of where you want your prescriptions filled
• Information about your family’s medical history (if you have it)
• A list of your allergies (to foods, medications, etc.)
• Questions/concerns you have about your diabetes, such as:
  • How do you get refills between appointments?
  • Who should you contact on nights or weekends if you have problems?
• Your referral (if you need one)
• Your insurance card(s)

Some insurance companies require you to get a referral (a document granting permission) from your primary care provider (PCP) before seeing a specialist (like a diabetes provider).

To find out if you need a referral to see your endocrinologist or diabetes care provider, call the phone number on the back of your insurance card and request to speak with someone in the member services department. Then ask if you need to have a referral to be seen by your diabetes team.

• If you require a referral, contact your primary care provider to request one. Know the name and contact information of the new diabetes provider you will be seeing. You should do this about a week before your appointment.
• Ask your primary care provider if the referral will be sent to the specialist directly or if you need to pick it up.
• If it is going to be sent directly from your primary care provider to the new diabetes provider, contact your specialist a few days before to confirm it was received. 
• IMPORTANT: You will not be able to be seen without the referral if your insurance requires it. 

Most adult providers do not expect parents to come to appointments with their young adult child. If you are 18 years old and would like your family to continue to speak with your adult diabetes team, you will be asked to sign a HIPAA form allowing your healthcare providers to speak with the person(s) you designate regarding your health condition. This includes phone contact, email contact or contact through electronic medical records. This consent would be needed if you were to become ill and not able to make contact with your providers directly. You should discuss this with your new diabetes team at your first appointment. You may want to ask about getting a Power of Attorney and having it put in your medical record so all your providers have access to it, if necessary.

Yes, you still will need an adult primary care provider (just like you needed a pediatrician as well as your pediatric diabetes team). Although some primary doctors may manage diabetes, most do not. When you are looking for a primary care doctor, search for one who has experience caring for young adults with diabetes.

Call your diabetes provider for any care related to your diabetes. So, if your blood sugar is high and not responding to insulin, you should call your diabetes team. However, if you are sick or experiencing health issues that are not an emergency and not related to another specialist you’re seeing, you should call your primary care provider.

If you are heading off to college or are entering the workforce, the Diabetes Center has resources with information on important topics.

• Managing Diabetes at College

• Managing Diabetes at Work 

• Managing your Prescriptions

• Understanding Insurance and Why Staying Insured Is so Important