Children and Young People’s Diabetes Team
The information in this leaflet is for young people with diabetes as they move from paediatric to adult services. It is designed to help you understand how you will move from the children’s diabetes service to the young person’s diabetes service.
The move between services should have been discussed and planned over a considerable period of time. This period is known as transition.
Aims of transitional care
- To provide you with high quality care appropriate to your age and development
- To support you in decision making and communicating your needs with health care professionals and others.
- To support you to become independent in the management of your diabetes
- To provide support and guidance for your parents or guardians during this process
When will it happen?
Transition will normally have been discussed following your 11th birthday, although this is only a guide and we base it around your individual needs regardless of your age and time of diagnosis.
Active preparation for the date of your transfer will have occurred over the past year or so, when you will have started to attend transition clinics; jointly with the children’s and adult teams.
- It will be around the age of 16 if you attend clinics at JCUH
Although there are exceptional circumstances where you may be kept within the children’s services for a while longer.
- It will be just before your 19th birthday if you attend clinics at FHN
Although you can chose to move at any point between your 16th and 19th birthday if you wish to do so.
How will it happen?
Your diabetes team should by now have commenced the goals of education for 14 to 15 year olds (relevant up to your 16th birthday) or 16 to 18 year olds (relevant up to your 19th birthday) which provide the ongoing framework for us to give you the necessary knowledge and skills required to enable you to manage your diabetes independently.
This will have been used throughout your transition period and will be passed on to the young people’s team so that they can continue to provide support and education.
It is important that your parents or carers remain involved in your care and they should continue to provide support and some supervision until you are fully independent. You can choose whether they come into your appointments from the start of the consultation or at the end of the consultation when the team will give them a brief overview of the key points of the appointment. You will be actively involved in discussions and decision making around your diabetes care.
As you approach your last appointment in the Transition clinic, the Paediatric Consultant will officially refer you to the Adult Consultant who is going to take over your care.
A letter will be sent with your details – this will include your most recent HbA1c and your current treatment regimen.
The Adult team will also be informed of any special circumstances, specific needs or concerns. You will then be sent an appointment for the young person’s clinic – this will be addressed to you.
After the age of 16, GP surgeries routinely contact patients to invite them to attend for annual review bloods. It is important that you continue to have these monitored once yearly, so if you receive an appointment for these then you should attend.
Your GP will continue to be responsible for your ongoing prescriptions so we recommend that you check how to order supplies and that you attend when requested for medication reviews.
If you fail to attend your appointments in the young person’s clinics, the team will contact your GP who may then call you in for a medication review; they may not issue further prescriptions of your medication until you are seen.
Young person’s diabetes team
You will have had the opportunity to meet with members of the young person’s diabetes team during clinic appointments before you move. This includes the consultant who deals with adults, the Diabetes Specialist Transition nurse and the Dietitian who will now be involved in your care.
When the time comes for you to move across to adult services it will be your responsibility to attend or to cancel or change appointments as necessary. You will no longer have direct access to PDU or the ward so if you have a problem with your diabetes, then you need to contact the adult diabetes specialist nurse.
In an emergency or outside of normal working hours you should contact your GP or out-of-hours GP service or you should attend the accident and emergency department.
You will be admitted to an adult ward if you need to come into hospital.
If you are studying at university away from home
It is advisable to register with the campus GP for prescriptions and emergency management while you are away. Outpatient appointments for review with the young person’s team can be arranged during holidays or when you are home.
- Young Persons Transition Nurse Specialist
Marie Presgrave (James Cook)
T: 01642 854235 this connects to an answerphone, please leave a message and your call will be returned.
Mobile: 07785 502096
- Diabetes Nurse Specialists (Friarage)
T: 01609 764810
- Dietitians (James Cook)
Leonie Garden: 01642 854777
- Dietitians (Friarage)
Kim Paterson: 01609 762012
- Dr Arut’s secretary and Dr Ali’s secretary (James Cook): 01642 855766
- Dr Siddaramaiah’s secretary (Friarage): 01609 762054
- Diabetes care centre reception (James Cook): 01642 854231
- Diabetes Care Centre (Friarage): 01609 764810
If you have any further questions or would like to discuss this further, please speak to a member of your diabetes team.
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.