Graduating high school and starting life at college can be exciting milestones. However, they can also be a stressful time for those with Type 1 diabetes. According to the National Center for Education Statistics, over three million students enrolled as freshman at university campuses across the U.S. in 2016. Based on current prevalence, about five percent (approximately 156,000) of students are estimated to have Type 1 diabetes. Before moving to campus, you need to be prepared to meet your diabetes health needs during this transition and learn about managing Type 1 diabetes in college.
After enrolling, contact the college’s disability service office. The term “disability” refers to an impairment that can substantially limit one or more major life activities. Type 1 diabetes meets this definition, and registering with the disability service office protects individuals with diabetes against discrimination. While you are not required to register, this service provides accommodations for issues that can occur due to diabetes. Accommodations they may provide upon your request include rescheduling a test missed due to high or low blood sugar, allowing food/drinks in class, or allowing a refrigerator or kitchen access in your dorm. Accommodations the college may not provide are those that may lower standards for academic programs.
By the time you’re old enough to go to college, you should be able to manage your diabetes independently. Before you get to campus, you need to develop a plan that includes access to resources and a diabetes care team. Consider the following when putting together your plan.
If your school is in a new city, identify a provider (physician, advanced practice nurse, physician’s assistant) that you will see for general health needs. Determine if you will continue to see your endocrinologist at home or if you will need to establish care nearby your college, especially if an emergency arises. In some cases, your endocrinologist at home may refer you to a diabetes educator that you can see near your college campus, especially if you need education related to your diabetes self-care.
Find a pharmacy on or close to campus and check to see if they accept your health insurance plan. If you get your diabetes medications and supplies at a large chain pharmacy at home, see if the same pharmacy is located at school so that you can access your prescriptions in either location. Another option might be online pharmacy/supply services that can deliver to you. Have a plan for refills to avoid running out of medications and supplies.
Review your sick day plan with your diabetes provider and/or educator. When you are sick and on your own, you will be responsible for monitoring your blood glucose and ketones. You should not skip your insulin when you are sick (even if you are not eating and/or vomiting). Skipping insulin should be done only if you are advised to do so by your diabetes care team. If you develop moderate to large ketones, you will need to check your blood glucose frequently (every two to three hours), give correction insulin based on your sick day plan and hydrate with sugar-free fluids. If you display any signs of diabetic ketoacidosis (DKA), a buildup of acids in your blood, or are unable to eliminate ketones within six hours, head to the nearest emergency room.
You should wear medical identification that includes your name, that you have Type 1 diabetes, and are insulin-dependent. A technology option, Medical ID, can be set up on Apple and Android smartphones. You can create your Medical ID in the health application (app) for Apple devices or in your contact information for Android devices. This information is accessible without unlocking your phone. Another app is RapidSOS, an option that prompts 911 dispatchers when called with your GPS location, demographic information, and relevant medical information. This app also has a Family Connect feature.
Moving into university housing can be exciting. While adjusting to dorm and campus life, you will need to identify your support system and support from individuals on campus who are familiar with your diabetes is ideal. A good place to start is with your roommate(s) and your resident advisor (RA). To help them understand Type 1 diabetes, discuss the basics of diabetes care. Teach them about your supplies, your insulin pen or pump, and your continuous glucose monitor (CGM). Review the highs and lows with blood glucose levels. Help them understand the various levels/symptoms of hypoglycemia and prompt oral treatment (15 to 20 grams of carbohydrate). They should also be familiar with glucagon administration in case of emergency hypoglycemia. Be sure they know where your glucose tablets and glucagon kit are stored. Educate them about the symptoms and the warning signs for DKA should your blood glucose be too high. Consider including your academic advisor in a discussion about your Type 1 diabetes. Chances are he or she has had a student with diabetes before and could have helpful insight for navigating your college studies and resources for students with diabetes. Consider sharing your diabetes data via technology with a close college friend and/or your family for safety reasons. Have a list of important numbers for your roommate and/or RA. Include your family, pharmacy, diabetes care provider and educator, health and prescription insurance provider, and student health and disability services. Customize your list to meet your individual needs.
Once out on your own, you will face many challenges and choices. As a college student with diabetes, you should be prepared to manage additional challenges and responsibilities. Think about what choices you can make to stay healthy. Pick a campus meal plan option that is best for you, keeping in mind price, variety, and nutrition. Ask the dining hall manager how you can access the nutrition facts information for the foods. Check out the exercise options both on campus and nearby. Exercise can help reduce stress and improve your blood glucose control. Most campuses have gyms for students, while other choices may include weight training and exercise classes. If the gym is a distance from your dorm room, see if a locker is available for you to store your supplies, snacks, and glucose tablets. At larger universities, factor in the walking distance to get from one class to another and how that might affect your blood glucose levels.
New experiences can also cause changes in your diabetes care. Your class routine may be hectic at times and different from one day to the next. You may be staying up later and pulling some all-nighters to study. Both lack of sleep and caffeine intake can contribute to hyperglycemia. Parties or study groups can involve carb-heavy foods such as pizza, which can wreak havoc on your blood glucose. Alcohol is often a new experience in college. While drinking alcohol under the age of 21 is against the law, many students may experiment with alcohol. Drinking alcohol, especially on an empty stomach, can contribute to severe hypoglycemia. After one to two drinks, the liver is busy processing the alcohol from your blood, which inhibits the liver’s production of glucose. In this case, glucagon, which is used to treat severe hypoglycemia, will not work. If you choose to drink, have a conversation with your diabetes care team about alcohol and the effects on Type 1 diabetes. Consider developing a plan for closely monitoring your blood glucose and any insulin adjustments when drinking, including care in the hours following alcohol consumption. Never drink and drive.
Congratulations! Off to college you go. Be proactive and prepared with a plan to make your college experience a safe and healthy one. If you want that degree, keeping your blood glucose levels in check will help you to stay healthy, feel well, and be productive. Be sure to keep your family and friends informed to minimize any worry they might have. After all, meeting your goals in both the college classroom and with your diabetes health will lead you to success.
Want to learn more about the teen and young adult years and diabetes? Read “Resolving Parent-Teen Conflicts,” “When Your Teen Just Quits: Diabetes and the Teenage Years,” and “Transitioning to Adult Diabetes Care.”
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