TRANSITIONING TO COLLEGETRANSITIONING TO COLLEGE

Jill Weissberg-Benchell, Ph.D.Jill Weissberg-Benchell, Ph.D.

NORMAL DEVELOPMENT NORMAL DEVELOPMENT MIDDLE ADOLESCENTS MIDDLE ADOLESCENTS

(14-17 YEARS OF AGE)(14-17 YEARS OF AGE)

You are going through lots of changes.You are going through lots of changes.• PhysicalPhysical• CognitiveCognitive• EmotionalEmotional• SocialSocial• FamilyFamily

How can you understand these changes How can you understand these changes to help you become an expert decision to help you become an expert decision maker/problem-solver?maker/problem-solver?

NORMAL DEVELOPMENT NORMAL DEVELOPMENT MIDDLE ADOLESCENTS MIDDLE ADOLESCENTS

(14-17 YEARS OF AGE)(14-17 YEARS OF AGE) PHYSICALPHYSICAL: : Puberty is ending. How do you Puberty is ending. How do you

get used to your new body?get used to your new body?

COGNITIVECOGNITIVE: : You are now a sophisticated You are now a sophisticated thinker.thinker.• Understand sarcasmUnderstand sarcasm• Understand hypocrisyUnderstand hypocrisy• Sometimes, you don’t pay attention to the risks or Sometimes, you don’t pay attention to the risks or

consequences of what you want to do until….consequences of what you want to do until….

Time-Lapse Imaging Tracks Brain Maturation from ages 5 to 20

•10-year NIH fMRI study•4-21 y.o. participants•Brain continues to Change until mid 20s

NORMAL DEVELOPMENT NORMAL DEVELOPMENT MIDDLE ADOLESCENTS MIDDLE ADOLESCENTS

(14-17 YEARS OF AGE)(14-17 YEARS OF AGE) EMOTIONALEMOTIONAL: Consolidate your Identity.: Consolidate your Identity.

• What are your values/morals?What are your values/morals?• Same/different than parents, peers, media?Same/different than parents, peers, media?

SOCIALSOCIAL: : • Friends – who are they?Friends – who are they?• Sexuality and dating – what do you want?Sexuality and dating – what do you want?• Activities/Interests – what makes you happy?Activities/Interests – what makes you happy?

– Academics, Recreation, SocialAcademics, Recreation, Social

FAMILYFAMILY: : • Relationship with parents is really changing Relationship with parents is really changing

NORMAL DEVELOPMENT NORMAL DEVELOPMENT EMERGING ADULTS (18-30)EMERGING ADULTS (18-30)

Mapping your course through life.Mapping your course through life. Searching for your place in societySearching for your place in society Searching for a sense of Searching for a sense of

commitment/attachment to others –commitment/attachment to others –friends and loves.friends and loves.

Balancing competing demands:Balancing competing demands:• Education, relationships, career buildingEducation, relationships, career building

EMERGING ADULTS (18-22)EMERGING ADULTS (18-22)

Arnett’s survey. 18-24 year olds. Arnett’s survey. 18-24 year olds. Hallmarks of being an adult:Hallmarks of being an adult:• Accept responsibility for yourselfAccept responsibility for yourself• Make independent decisionsMake independent decisions• Become financially independentBecome financially independent• Independently form beliefs and valuesIndependently form beliefs and values

VERY few believed they achieved these VERY few believed they achieved these goals. goals.

EARLY PHASE OF EARLY PHASE OF EMERGING ADULTS (18-22)EMERGING ADULTS (18-22)

Key Goals:Key Goals:• Finding/keeping a place to liveFinding/keeping a place to live• Paying billsPaying bills• Balancing check bookBalancing check book• Managing creditManaging credit• Relationships that may be “forever”Relationships that may be “forever”• Choosing a careerChoosing a career

Now with less help/structure/support than Now with less help/structure/support than before.before.

Now must weave daily health-related Now must weave daily health-related demands into all of these normative demands into all of these normative demands.demands.

SURVIVAL ADVICESURVIVAL ADVICE

Self- Care is NOT EASYSelf- Care is NOT EASY Lapses are NOT a sign of failureLapses are NOT a sign of failure

• Life can get in the wayLife can get in the way• Lapses Lapses ≠ going on strike ≠ there’s no point to ≠ going on strike ≠ there’s no point to

trying.trying.• Don’t skip appointmentsDon’t skip appointments

Set goals that are achievable.Set goals that are achievable. Everyone works/learns at a different pace.Everyone works/learns at a different pace.

THE BASIC SKILLSTHE BASIC SKILLSKnowledgeKnowledge

InsulinInsulin• Take insulin without reminders?Take insulin without reminders?

• Know when insulins peak in your body? Know when insulins peak in your body?

• Know how long each insulin lasts?Know how long each insulin lasts?

• Adjust insulin based on blood sugar Adjust insulin based on blood sugar readings?readings?

• Adjust insulin based on carbs consumed?Adjust insulin based on carbs consumed?

• Adjust insulin based on exercise?Adjust insulin based on exercise?

THE BASIC SKILLSTHE BASIC SKILLSKnowledgeKnowledge

Blood SugarsBlood Sugars• NOT a report cardNOT a report card

• Check blood sugars without reminders?Check blood sugars without reminders?

• Use blood sugar #’s to identify patterns?Use blood sugar #’s to identify patterns?

• Use blood sugar #’s to determine dose?Use blood sugar #’s to determine dose?

• Use #’s to decide if it’s safe to drive?Use #’s to decide if it’s safe to drive?

• Use #’s to decide if you have successfully Use #’s to decide if you have successfully treated a low?treated a low?

THE BASIC SKILLSTHE BASIC SKILLSKnowledgeKnowledge

HypoglycemiaHypoglycemia• Supplies for treating lows?Supplies for treating lows?

• Where do you keep them?Where do you keep them?

Carbohydrates/FoodsCarbohydrates/Foods• Carb counting skills?Carb counting skills?

• Judging portion sizes?Judging portion sizes?

• Reading labels?Reading labels?

THE BASIC SKILLSTHE BASIC SKILLSKnowledgeKnowledge

ExerciseExercise• Great way to burn off calories/ achieve Great way to burn off calories/ achieve

weight goalsweight goals• Blood sugar checking is keyBlood sugar checking is key

–SafetySafety–Effective workoutEffective workout

• Check blood sugars two hours afterCheck blood sugars two hours after• Eat carbs if numbers lower than 120Eat carbs if numbers lower than 120• Reduce insulin if you don’t want to add Reduce insulin if you don’t want to add

carbscarbs

THE BASIC SKILLSTHE BASIC SKILLSKnowledgeKnowledge

Alcohol Alcohol • Most dangerous is alcohol related lowsMost dangerous is alcohol related lows• Mostly if you drink without foodMostly if you drink without food• Drinking prevents liver from putting out glucose when Drinking prevents liver from putting out glucose when

you need it for handling a low. you need it for handling a low. • It’s easy to forget to check blood sugars and to forget to It’s easy to forget to check blood sugars and to forget to

eat (and to forget other things) when you are drunkeat (and to forget other things) when you are drunk• Limit to 2 drinks/dayLimit to 2 drinks/day• Always have food in your stomachAlways have food in your stomach• Always have carbs with you a few hours later – you are Always have carbs with you a few hours later – you are

still at risk for lows!still at risk for lows!

• Always with a buddy who knows signs/symptomsAlways with a buddy who knows signs/symptoms

THE BASIC SKILLSTHE BASIC SKILLSAction PlansAction Plans

How to fill a prescriptionHow to fill a prescription How to pay for a prescriptionHow to pay for a prescription Order supplies before running outOrder supplies before running out How to make an apptHow to make an appt How to contact diabetes team membersHow to contact diabetes team members Have a sick day planHave a sick day plan

THE BASIC SKILLSTHE BASIC SKILLSSupplies to BringSupplies to Bring

Medical recordsMedical recordsSharps containersSharps containersAll blood sugar checking items’All blood sugar checking items’Insulin/syringes/pump and CGMS suppliesInsulin/syringes/pump and CGMS suppliesKetone stripsKetone stripsReady sources of glucoseReady sources of glucoseMedical alert idMedical alert idPhone numbersPhone numbersInsurance cardInsurance cardSick day suppliesSick day supplies

Thermometer, jello, saltines, broths, over the counter Thermometer, jello, saltines, broths, over the counter meds, cough dropsmeds, cough drops

SCHEDULING CONSIDERATIONSSCHEDULING CONSIDERATIONS

Your schedule will be unpredictable. Can your Your schedule will be unpredictable. Can your insulin regimen handle that?insulin regimen handle that?

You will not have regular meals and you’ll eat You will not have regular meals and you’ll eat late at night. Can you consult with a dietitian for late at night. Can you consult with a dietitian for tips on how to handle that?tips on how to handle that?

Can you get carb counts from cafeteria?Can you get carb counts from cafeteria? Figure out where and how you can get healthy Figure out where and how you can get healthy

foods.foods. Your friends will eat whatever is in your roomYour friends will eat whatever is in your room Where will you keep ready access carbs? In Where will you keep ready access carbs? In

room, in back pack, etc.room, in back pack, etc.

PSYCHOSOCIAL NEEDSPSYCHOSOCIAL NEEDSRelationships with PeersRelationships with Peers

You are away from your closest friends and You are away from your closest friends and your family. How do you get in touch with your family. How do you get in touch with them for support?them for support?

How do you find other people who will be How do you find other people who will be there for you?there for you?

Normal to feel alone/isolated.Normal to feel alone/isolated.

PSYCHOSOCIAL NEEDSPSYCHOSOCIAL NEEDSRelationships with PeersRelationships with Peers

Who To Tell?Who To Tell?• Who do you spend the most time with?Who do you spend the most time with?• Legal/honest for insurance/driver’s license applicationsLegal/honest for insurance/driver’s license applications• Roomate? Lab Partner? Coach? RA?Roomate? Lab Partner? Coach? RA?

What To Tell?What To Tell?• Clarify Misperceptions (“forbidden foods”)Clarify Misperceptions (“forbidden foods”)• How to treat lowsHow to treat lows• Where you keep suppliesWhere you keep supplies

When To Tell?When To Tell?• What is your own sense of comfort/timing?What is your own sense of comfort/timing?

PSYCHOSOCIAL NEEDSPSYCHOSOCIAL NEEDSRelationships with ParentsRelationships with Parents

Call your mom –she worries!Call your mom –she worries!

• Keep them up to date about your healthKeep them up to date about your health

• Talk about experiences with new Talk about experiences with new providersproviders

PSYCHOSOCIAL NEEDSPSYCHOSOCIAL NEEDSRelationships with ParentsRelationships with Parents

Helping Your ParentsHelping Your Parents::

• ALWAYS talk about Normal things first. ALWAYS talk about Normal things first.

• Accept your independence while still Accept your independence while still remaining connected.remaining connected.

• Pay attention to their tone of voice when Pay attention to their tone of voice when talking about medical things. talking about medical things.

• Asking you what things they can do that Asking you what things they can do that you would find helpful.you would find helpful.

DECISIONS: DECISIONS: YOUR MEDICAL TEAMYOUR MEDICAL TEAM

Will you still see your pediatric providers? Will you still see your pediatric providers? How will you get in contact with them?How will you get in contact with them?

Do you have copies of your medical records Do you have copies of your medical records and where will you keep them if you need and where will you keep them if you need them?them?

Did you contact the university health center Did you contact the university health center to see what they can provide?to see what they can provide?

Are you comfortable telling medical people Are you comfortable telling medical people how you feel?how you feel?

Are you comfortable asking them questions?Are you comfortable asking them questions?

DECISIONS: DECISIONS: YOUR MEDICAL TEAMYOUR MEDICAL TEAM

Can You Be an Effective Patient?Can You Be an Effective Patient?• Finding a Finding a teamteam that understands YOU make the day that understands YOU make the day

to day decisions. to day decisions.• Finding a Finding a teamteam that’s up to date on research & that’s up to date on research &

technology.technology.• Finding a Finding a teamteam that knows they’re your coach or that knows they’re your coach or

guide. They don’t dictate what you “should” or guide. They don’t dictate what you “should” or “must” do.“must” do.

• Remembering to ask for the things you needRemembering to ask for the things you need– PrescriptionsPrescriptions– LettersLetters

• Feeling comfortable talking about the annoyances so Feeling comfortable talking about the annoyances so you have others to help you problem-solve.you have others to help you problem-solve.

• Less time in clinics in adult programs (@15min).Less time in clinics in adult programs (@15min).