July 2019 Issue

Diabetes Management & Nutrition Guide: Preparing the College-Bound for Diabetes Self-Care
By Toby Smithson, MS, RDN, LD, CDE
Today’s Dietitian
Vol. 21, No. 7, P. 48

Many high school seniors across the country are preparing to go to college away from home. And while there’s much to pack and think about for the average teenager (eg, finding new friends, assimilating in their new environment, juggling college coursework, and getting along with roommates), there’s even more to pack, prepare for, and think about for the teen who has type 1 diabetes.

For them, going to school away from home will be exciting, scary, and frustrating because, for the first time, they’ll be managing their disease all by themselves. However, many of these teens will have transitioned into more advanced self-care behaviors during high school. Once children are between the ages of 13 and 18, they become more independent and responsible and are more likely to understand the association between behavior choices and long-term health.

One thing today’s teens with diabetes have going for them is tech savviness; they have all of the tools, from insulin pumps to continuous glucose monitoring systems. Typically, high school students will manage their insulin pumps or administer injections on their own. They’re counting carbohydrates using one of several apps (eg, Fooducate, CalorieKing, and MyFitnessPal) and have experience determining which foods trigger high and low blood sugar levels. Many students simply do Google searches as needed for the nutrition content of foods. However, even with their use of technology, teens still may rely on their parents to help them manage their diabetes—something they’ll miss when they leave home for college.

Elizabeth Brookshire, a senior at South Carolina’s Clemson University, who has type 1 diabetes, suggests doing a diabetes self-management practice run the year before going to college. She recommends students shadow their parents and learn the logistics associated with their diabetes management, such as medical insurance, ordering supplies, and making sure reorders are scheduled in a timely manner. Doing a walkthrough with parents can minimize stress and better prepare students for college. However, Brookshire warns, there are several hoops students will jump through to maintain health. Her suggestion for dietitians: Guide patients on how to be their own health advocate.

What follows are five of the most common challenges college students with type 1 diabetes encounter and tips on how they can overcome them.

1. Unpredictable Schedules
Dealing with unpredictable class schedules, late-night studying, and disrupted sleep patterns is common for college students, but these can lead to sporadic spikes and dips in blood glucose levels, making it difficult to gauge blood sugar patterns that are critical for problem solving. This is in addition to the many social activities on campus that can throw off students’ diabetes management schedules. Advise college students to check their blood glucose levels more often when their schedules become unpredictable. This will help them determine the amount of physical activity they need, make better food choices, and adjust their insulin regimen to help keep blood sugar as close to target as possible.

2. Choosing Healthful Foods
The menu choices at college will be different from Mom’s cooking at home, and, initially, carb counting may be a challenge. At home, students most likely determined how certain foods affected their blood glucose levels. Suggest students check their blood sugar before eating and two hours after the first bite to help them determine how new foods affect their blood glucose. Dietitians also should advise students to speak with the foodservice department about getting nutrient analyses of the foods being served so they can use them as a guide for making the best choices in the dining hall.

3. Dealing With Stress
Undoubtedly, students will experience higher levels of stress while in college due to trying to fit in socially, studying for exams, and keeping up with class projects and homework. This increased stress can raise blood glucose. To relieve this stress, suggest students explore yoga, meditation, or visual imagery. Dietitians also can recommend students seek peer support on campus that involves meeting and befriending fellow students with type 1 diabetes; they can discuss the issues surrounding their diabetes management and other common issues they encounter.

4. Finding Peer Support
A peer support network on campus can serve as a safety net for college students with diabetes and their parents. Students will need people they can trust and who can be available for them during times when they need help and support with diabetes management. One of the most progressive support groups is the College Diabetes Network (CDN), a national nonprofit organization offering young adults with type 1 diabetes and their families a wealth of resources. While it also provides resources for those with type 2, its main focus is helping students with type 1 diabetes connect with their peers. CDN has more than 3,500 members, 224 campus chapters, and over 30 resources for students and their families. Parents and students can visit https://collegediabetesnetwork.org to learn how to plan for college three months in advance of arriving on campus and for other valuable information. Other resources include Affordable Colleges Online at www.affordablecollegesonline.org/college-resource-center/students-with-diabetes and the American Diabetes Association at http://diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/special-considerations/college-and-beyond.html.

Former college student Hannah Kramer was diagnosed with type 1 diabetes while she was in school. She encourages students with diabetes to extend a great deal of grace to people who may not know anything about the disease. She offers a reminder that everyone comes to college to learn and that diabetes will provide many teaching moments. Kramer recommends students be generous with the information they share about diabetes but not feel they must discuss their medical condition with everyone. She says the most important consideration for students is to avoid putting themselves at risk by overlooking peer support if and when they need advice, encouragement, or medical assistance. Her advice to students with diabetes: “You are valuable, so speak up and be kind.”

Brookshire connected with her roommate ahead of time to let her know about her diabetes. She educated her roommate and close friends on the signs, symptoms, and protocol for treating low blood sugar in case she ever showed signs of a dangerously low reading.

5. Embracing the Learning Curve
It’s important for dietitians to tell college-bound students that they will experience many moments of trial and error while managing their diabetes. No matter how long a person has had the disease, managing it is a learned process, and problem solving remains constant, especially when routines change. Brookshire says it would be great if dietitians could tell students they will experience a learning curve in their diabetes care, and that they must work harder than they desire at times to balance diabetes management with social activities and academic responsibilities.

Planning Is Key
Planning in the form of a checklist can serve as a tool before students move in on campus. Planning equals preparation, and preparation can reduce stress.

Dietitians can offer students the following advice:

• Encourage students and families to reach out. Kramer, who works in higher education admissions, suggests contacting the office of disability services even if students don’t think they’ll need them. Since type 1 diabetes is covered under the Americans With Disabilities Act, this is the office that will be the most helpful for them. Students can learn about available resources when they tour the campus, during orientation, or at any time. Kramer asserts that services can be hard to find without assistance because they often fall under names of organizations that obscure them, eg, Accessibility Resource Center.

• Ensure they know their rights. Recommend patients review resources that will inform them about their rights as persons with diabetes. The American Diabetes Association offers “Going to College With Diabetes: A Self Advocacy Guide for Students,” a booklet that explains students’ legal rights on campus and during the admissions process, how to work with their disability services office, what academic modifications are available, and other valuable information. Students can access the booklet at http://main.diabetes.org/dorg/PDFs/Advocacy/Discrimination/going-to-college-with-diabetes.pdf.

• Make copies of medical insurance cards and set up an account at a pharmacy near campus or use mail order for their medication deliveries. Ask students to check whether they will remain on their parent’s medical plan or switch to their college health plan.

• Contact an endocrinologist or internist near campus. This is an important task, as students may need to see a physician while at school to address unforeseen medical issues and maintain health. Some universities are associated with teaching hospitals near campus; this could facilitate a connection.

• Suggest students carry a medical ID necklace, bracelet, or wallet card to identify they have diabetes. It’s suggested to list which type of diabetes, diabetes medications used, and an emergency contact name and phone number. If students aren’t comfortable wearing such ID, they can complete the medic ID information on their cell phone’s health app.

• Request a refrigerator in the dorm room to hold extra insulin supplies and perishable foods for snacks or meals.

• Counsel students on the signs and symptoms of hypoglycemia and hyperglycemia. Review treatment of low blood sugar designated as the “rule of 15.” Suggest they carry fast-acting carbohydrate sources at all times so they’re prepared to treat low blood sugar immediately. And recommend they carry diabetes supplies for managing low or high blood sugar readings.

• Develop a contact list. Suggest students add phone numbers to their address books on their cell phones for times when they may need to call family members, friends, a pharmacy, doctor, or certified diabetes educator.

• Recommend students discuss alcohol consumption, sick days, drug use, sexual activity, and peer pressure with their doctors and diabetes educators and develop a plan for diabetes management when faced with these situations.

Diabetes management in young adults has come a long way. When I went to college with type 1 diabetes, I didn’t have the CDN community or any of the helpful diabetes technologies to help me with self-care. Encourage students to take advantage of these resources and remind them to touch base with their medical care team for diabetes management recommendations before heading to college. Suggest they use all these resources and discuss strategies for making a smooth transition.

— Toby Smithson, MS, RDN, LD, CDE, is a diabetes lifestyle expert, speaker, writer, consultant dietitian, and author of Diabetes Meal Planning & Nutrition for Dummies. She has successfully managed her own type 1 diabetes for more than five decades, and in 2010 founded DiabetesEveryDay.com and a YouTube channel to offer online technical and lifestyle support resources for people with diabetes. Smithson is based in Hilton Head Island, South Carolina.