The transfer of responsibility for diabetes management from parent to child has been seen as a central challenge for the clinical care of adolescents with Type 1 diabetes. Research is needed to better understand how clinicians, patients, and families handle the delicate balance between parental involvement and adolescent responsibility for diabetes management. The aim of this study is to investigate the interactional processes by which an adolescent’s autonomy is facilitated and constrained in a clinical interaction between a nurse practitioner (NP), a 13-year-old diabetes patient, and the patient’s mother. Integrating psychological perspectives on adolescent autonomy and responsibility with conversation analytic approaches to participation, I examine participation frameworks and shifting alignments to illuminate the negotiation of adolescent autonomy within a single clinical encounter. The analysis demonstrates that the patient’s autonomy is emphasized while identifying problems, yet restricted when considering solutions. Clinical implications are discussed.