Moving On… To Adult Care

As a teenager, you'll probably find yourself busy juggling things like study, work, relationships, finances and parties. You may be thinking about the future, things like work, uni and moving out of home. Having diabetes on top of all the usual teenage stuff like a busy social life and lots of demands can be tricky to manage.

As you get older you'll also find that you move on from paediatric to adult diabetes care. Depending on where you go, this might happen in your late teenage years or when other things change e.g. you start going to work. At this stage when you've got so much other stuff going on, it can be hard to keep up with managing your diabetes. It’s well known that many young people ‘drop out of the system’ at this time in their lives and end up with lots of admissions to hospital as their diabetes gets in the way of day to day living. To avoid this happening to you, it’s important to plan your move from paediatric to adult care so that you can still enjoy yourself without running into too much trouble with your diabetes.

Paediatric or adult care – what’s the difference?
The paediatric system is a very supportive environment where your parents are mostly responsible for making sure you get to clinic and helping you manage your diabetes. HbA1c screening is performed at clinic and complications screening is done yearly and mostly on the one day. Most paediatric centres have an after hours number that can be called if you need help with your diabetes. If you live in the country or see a doctor privately then this may be managed a little differently.

The adult system -
This is a time when you start realising you're the one now responsible for your diabetes.

The adult system is very different and attending clinic for the first time can be a shock. You might find that waiting rooms are filled with people of all ages with different types of diabetes and waiting times in public hospitals can be long. You’ll see the doctor by yourself in the adult system and you need to know that what is said between you and the doctor and other health professionals is confidential. In other words they won’t be discussing your care with your parents unless it’s with your permission and with you present. This is a time when you start realising that you’re the one now responsible for your diabetes.

Blood Tests
Many adult centres don’t have a HbA1c machine and you'll be sent off to have blood taken every time you see the specialist. This can mean having to wait for results after your appointment, unless the test is done in advance.

Complications screening
Complications screening is organised by your specialist but isn’t necessarily done at the one appointment. Further appointments with other specialists (eg. eyes, kidneys) are often needed. It’s also up to you now to remember and ask for your complications screening to be done.

Understanding it all…

Hospital Clinics
Hospital clinics are free under Medicare but you'll need a referral from your GP. A specialist is in charge of the clinic and oversees the work of the trainee doctors. You may or may not see the same doctor each time. At the hospital clinic you'll also have the opportunity to see a diabetes educator and dietitian.

Private Specialist Doctors
A referral is needed from your GP. You’ll be charged a fee and there'll be a gap to pay between the Medicare payment and fee charged. You’ll need to complete a form for Medicare to get your money back. Under special circumstances (financial hardship) the specialist may negotiate the payment of the gap. You’ll see the same doctor every time and they'll keep in touch with your GP. You can also let your specialist know if you want letters sent to any other health professionals. A diabetes educator and dietitian are usually not available at private specialist clinics, so you'll need to arrange this separately.

The Role of the GP
It’s really important that you have a regular GP that you get along with and trust. It’s good to have someone else who can help and who knows what’s happening to you. If you get sick your GP can help and be in contact with your specialist. Medicare may cover visits to the GP if they bulk bill. Your GP can help with emergency insulin scripts, general illness and referrals to other health professionals, however, it’s still important that you see a diabetes specialist.

Private Health Funds
Private health funds cover many areas, there are different levels and the costs vary. Private health insurance can help with the cost of private hospital admissions, the cost of seeing other health care professionals in private practice (eg. psychologists, dietitians, and physiotherapists) – each fund deals with this differently. Private health Funds do not cover costs of seeing your diabetes specialist (except for hospital). You don’t have to be in a private health fund to see a specialist privately.

Other stuff to think about…

Transport
Getting yourself to appointments can be a challenge as your situation changes. There may not be anyone to take you to appointments and you may have to rely on public transport. There may not be enough time to get there between lectures or after work. The hours for most appointments are between 9 and 5pm. You need to think about all of this and plan ahead.

Not many centres run an after-hours or weekend clinic that you can attend. Some private specialists do a late clinic so this may make it easier to find a suitable time that fits in with you.

Diabetes Education
It’s important that you get an update about diabetes management, especially if your parents were the ones who were initially educated when you were diagnosed. There are many other things you need to think about like alcohol, driving, contraception, pregnancy and parties. You need to understand how to manage when you’re sick, how to adjust your insulin and manage from day to day.

Bridging the Gap…

It's often better to move on to adult care before you've left school, while you still have the support of family.

Some children's hospitals will arrange to share care between paediatric and adult specialists. This way you can have the best of both worlds until you get used to the adult care. Ask your diabetes team about this.

Getting Connected

Getting Connected is a guide for young people with diabetes to help with the transfer to adult health services. Click on the link below to download this document.
Getting Connected pdf

To find the diabetes centre nearest to you, go to the Australian Diabetes Educators Association web site www.adea.com.au

Acknowledgments – Moving on / Getting Connected

Greater Metropolitan Clinical Taskforce (GMCT) – Transition Care Program

Caring for Diabetes in Children & Adolescents – edited by Geoff Ambler, Elizabeth Ambler, Vicki Barron, Fergus Cameron & Chris May

Jennie Hales, Social Worker, Diabetes Centre Gosford

Wendy Livingstone, Diabetes Educator, Ballina/Byron Diabetes Centre

Angie Llewellyn, Diabetes Educator formerly of the Transition Program at Westmead Hospital