1. TRANSITIONING TO COLLEGE Jill Weissberg-Benchell, Ph.D.

2. NORMAL DEVELOPMENT MIDDLE ADOLESCENTS (14-17 YEARS OF AGE) n You are going through lots of changes. PhysicalPhysical CognitiveCognitive EmotionalEmotional SocialSocial FamilyFamily n How can you understand these changes to help you become an expert decision maker/problem-solver?

3. NORMAL DEVELOPMENT MIDDLE ADOLESCENTS (14-17 YEARS OF AGE) n PHYSICAL: Puberty is ending. How do you get used to your new body? n COGNITIVE: You are now a sophisticated thinker. Understand sarcasmUnderstand sarcasm Understand hypocrisyUnderstand hypocrisy Sometimes, you dont pay attention to the risks or consequences of what you want to do until….Sometimes, you dont pay attention to the risks or consequences of what you want to do until….

4. 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

5. NORMAL DEVELOPMENT MIDDLE ADOLESCENTS (14-17 YEARS OF AGE) n EMOTIONAL: 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? n SOCIAL: 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, Social n FAMILY: Relationship with parents is really changingRelationship with parents is really changing

6. NORMAL DEVELOPMENT EMERGING ADULTS (18-30) n Mapping your course through life. n Searching for your place in society n Searching for a sense of commitment/attachment to others – friends and loves. n Balancing competing demands: Education, relationships, career buildingEducation, relationships, career building

7. EMERGING ADULTS (18-22) n Arnetts survey. 18-24 year olds. 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 n VERY few believed they achieved these goals.

8. EARLY PHASE OF EMERGING ADULTS (18-22) n 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 foreverRelationships that may be forever Choosing a careerChoosing a career n Now with less help/structure/support than before. n Now must weave daily health-related demands into all of these normative demands.

9. SURVIVAL ADVICE n Self- Care is NOT EASY n Lapses are NOT a sign of failure Life can get in the wayLife can get in the way Lapses going on strike theres no point to trying.Lapses going on strike theres no point to trying. Dont skip appointmentsDont skip appointments n Set goals that are achievable. n Everyone works/learns at a different pace.

10. THE BASIC SKILLS Knowledge n Insulin 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 readings?Adjust insulin based on blood sugar readings? Adjust insulin based on carbs consumed?Adjust insulin based on carbs consumed? Adjust insulin based on exercise?Adjust insulin based on exercise?

11. THE BASIC SKILLS Knowledge n Blood 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 its safe to drive?Use #s to decide if its safe to drive? Use #s to decide if you have successfully treated a low?Use #s to decide if you have successfully treated a low?

12. THE BASIC SKILLS Knowledge n Hypoglycemia Supplies for treating lows?Supplies for treating lows? Where do you keep them?Where do you keep them? n Carbohydrates/Foods Carb counting skills?Carb counting skills? Judging portion sizes?Judging portion sizes? Reading labels?Reading labels?

13. THE BASIC SKILLS Knowledge n Exercise Great way to burn off calories/ achieve weight goalsGreat way to burn off calories/ achieve weight goals Blood sugar checking is keyBlood sugar checking is key –Safety –Effective 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 dont want to add carbsReduce insulin if you dont want to add carbs

14. THE BASIC SKILLS Knowledge n 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 you need it for handling a low.Drinking prevents liver from putting out glucose when you need it for handling a low. Its easy to forget to check blood sugars and to forget to eat (and to forget other things) when you are drunkIts easy to forget to check blood sugars and to forget to eat (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 still at risk for lows!Always have carbs with you a few hours later – you are still at risk for lows! Always with a buddy who knows signs/symptomsAlways with a buddy who knows signs/symptoms

15. THE BASIC SKILLS Action Plans n How to fill a prescription n How to pay for a prescription n Order supplies before running out n How to make an appt n How to contact diabetes team members n Have a sick day plan

16. THE BASIC SKILLS Supplies to Bring Medical records Medical records Sharps containers Sharps containers All blood sugar checking items All blood sugar checking items Insulin/syringes/pump and CGMS supplies Insulin/syringes/pump and CGMS supplies Ketone strips Ketone strips Ready sources of glucose Ready sources of glucose Medical alert id Medical alert id Phone numbers Phone numbers Insurance card Insurance card Sick day supplies Sick day supplies Thermometer, jello, saltines, broths, over the counter meds, cough drops

17. SCHEDULING CONSIDERATIONS n Your schedule will be unpredictable. Can your insulin regimen handle that? n You will not have regular meals and youll eat late at night. Can you consult with a dietitian for tips on how to handle that? n Can you get carb counts from cafeteria? n Figure out where and how you can get healthy foods. n Your friends will eat whatever is in your room n Where will you keep ready access carbs? In room, in back pack, etc.

18. PSYCHOSOCIAL NEEDS Relationships with Peers n You are away from your closest friends and your family. How do you get in touch with them for support? n How do you find other people who will be there for you? n Normal to feel alone/isolated.

19. PSYCHOSOCIAL NEEDS Relationships with Peers n Who To Tell? Who do you spend the most time with?Who do you spend the most time with? Legal/honest for insurance/drivers license applicationsLegal/honest for insurance/drivers license applications Roomate? Lab Partner? Coach? RA?Roomate? Lab Partner? Coach? RA? n 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 n When To Tell? What is your own sense of comfort/timing?What is your own sense of comfort/timing?

20. PSYCHOSOCIAL NEEDS Relationships with Parents n 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 providersTalk about experiences with new providers

21. PSYCHOSOCIAL NEEDS Relationships with Parents n Helping Your Parents: ALWAYS talk about Normal things first.ALWAYS talk about Normal things first. Accept your independence while still remaining connected.Accept your independence while still remaining connected. Pay attention to their tone of voice when talking about medical things.Pay attention to their tone of voice when talking about medical things. Asking you what things they can do that you would find helpful.Asking you what things they can do that you would find helpful.

22. DECISIONS: YOUR MEDICAL TEAM n Will you still see your pediatric providers? How will you get in contact with them? n Do you have copies of your medical records and where will you keep them if you need them? n Did you contact the university health center to see what they can provide? n Are you comfortable telling medical people how you feel? n Are you comfortable asking them questions?

23. DECISIONS: YOUR MEDICAL TEAM n Can You Be an Effective Patient? Finding a team that understands YOU make the day to day decisions.Finding a team that understands YOU make the day to day decisions. Finding a team thats up to date on research & technology.Finding a team thats up to date on research & technology. Finding a team that knows theyre your coach or guide. They dont dictate what you should or must do.Finding a team that knows theyre your coach or guide. They dont dictate what you should or must do. Remembering to ask for the things you needRemembering to ask for the things you need –Prescriptions –Letters Feeling comfortable talking about the annoyances so you have others to help you problem-solve.Feeling comfortable talking about the annoyances so you have others to help you problem-solve. Less time in clinics in adult programs (@15min).Less time in clinics in adult programs (@15min).