It is May and our high school seniors have received those thin and fat envelopes determining their educational fate for the next academic year. Many will be living on their own for the very first time and have to become independent without the immediate support of parents. This task of "letting go" is a major developmental milestone for both the child and family members, especially parents (and even more typically - mothers). This transition is exceedingly tough and emotionally stressful. It is hard enough to send your child to a new environment away from the nest, but it is even harder to leave your child with diabetes in the midst of a bustling college dormitory! I certainly was no exception. After bidding farewell to my then 18-year-old son in the middle of the Arts Quad of Cornell University, I began sobbing and did not stop until arriving home 6 hours later. That first month was extremely difficult.
Now, add the additional layers of complexity in children and teens with diabetes, in which the family has played a major supportive role for many years. MAJOR STRESS!
1. Who ensures that your child is checking blood sugars at least four times/day?
2. Are they bolusing insulin for their carbs correctly?
3. Are they correcting blood sugars?
4. Do they have rapid acting carbohydrates available at all times?
5. What if they go low overnight?
6. Who is going to check their blood sugars at 3 am? (I know that parents will want to, and would if at all humanely possible! Maybe a remote blood glucose meter?)
7. Does that Resident Advisor know how to administer glucagon?
8. Who will check if my teen drinks alcohol and goes "low?"
9. What if they run out of insulin and forget to get refills?
10. Etc., Etc., Etc.
I am sure that parents could add at least 100 more concerns to this very short list. And, you do have merit in your anxieties about your young adult. So, how do the child, siblings, and parents emerge from this major transition without having severe emotional repercussions?
I have written past blogs about Developmental milestones in infants, toddlers, elementary schoolchildren, and adolescents. This particular developmental milestone (leaving the family environment) occurs as your adolescent becomes a young adult. How does one prepare for this disruption?
As with any change in family dynamics, it helps to be informed about "what to expect" in terms of child development. It is important to be prepared ahead of time so that reactions are not unexpected. Take advantage of your diabetes team to help prepare your young adult (and your family) for this major transition. As my students go through their senior year in high school, I begin to discuss different issues during each of my diabetes follow-up visits (with or without parent in the exam room):
1. The choice of the best college fit for their unique needs and personalities
2. Barriers that might occur as they move from home to college
3. Strategies to help with independence, and specifically with diabetes self-care tasks
4. Emotional ups and downs that might affect blood sugar levels (SATs, AP, IB exams, college acceptances, rejections, etc.)
5. Handling parental anxiety as the parent transfers many responsibilities to the emerging adult
6. Individual fears and concerns
7. Drugs, alcohol, and sex
8. Who should know that you have diabetes, and should they know how to help (resident advisors, roommates, etc.)
9. Phone/fax numbers and e-mail addresses to contact the diabetes team
These visits help the family, caregiver, and child go through the process of letting go. However, for things to go as smoothly as possible, I would suggest that the parents and teen do as many "trial runs" as possible prior to college so that there is immediate back-up if necessary. Say "yes" to the overnight sleepover at a friend's home and indicate the requirements necessary to provide peace of mind to both you and your teen. Expect your young adult to perform as directed; or consequences will occur. Some families have their teen call or text the next morning to reassure their parents. Others will have their child set an alarm in a cell phone to remind the student that it is time to check blood sugars. Of course, your teen will need to be responsible for all diabetes related equipment to socialize and be independent. Now is the time to start getting ready for the big day, not two weeks before moving far away. Keep practicing with your young adult and provide different scenarios on how to respond appropriately and safely. Be happy if your child is confronted with a problem (forgot to test, take insulin, etc.) and solved it on his own without the need to contact you for help! Support his independence and take solace that he will be safe at college after he has demonstrated that he can perform all of his self-care skills independently at home. One caveat: he may not do these diabetes related tasks the way an adult caregiver would want them done!
As the parent or caregiver delegates more and more responsibilities (diabetes and other) to a young adult while living at home without major issues, the parent (and child) will become more comfortable. Communication is key! Letting go works best over a LONG time span so that when the big day comes, you all will be ready!
Be prepared to cry, though!