Creating a Diabetes Care Plan When Heading Off to College
Madison, Wisconsin – Mikayla, a sophomore nursing student at the University of Wisconsin-Madison, was surprised at the change in her blood sugar levels when she felt the stress of her academic load during her freshman year.
"It makes you go really high," she said to a group of recent high school graduates attending the "Diabetes College Course" organized by UW Health diabetes and endocrinology specialists Ellen Connor, MD, and registered nurse Misty Romero Rivera.
Joe, a sophomore on the Macalester College baseball team, encouraged College Course participants to be open about their diabetes, as he was in telling his roommate and teammates.
"It's not something you should be shy about or ashamed of," he said. "People deserve to know, so if you need help, they'll be there for you and understand that you're not freaking out for no reason."
Dr. Connor asked Mikayla and Joe to talk to the College Course attendees because they know what the rising freshmen are facing, and are living proof that young men and women with diabetes can thrive under the demands of college.
"We've been doing this since 1999," Dr. Connor said. "The class is designed to tell freshmen with type 1 diabetes how to manage their diabetes when they're well and when they get sick, how to eat in a college cafeteria without mom's cooking, how to deal with alcohol. These are things they need to know to take responsibility for their own diabetes care."
It's a subtle but crucial transition. Kids with diabetes are well aware of the importance of monitoring blood sugar levels, injecting insulin and keeping track of their carbohydrate intake, but most maintain their diabetes care regimens under the watchful eyes of mom and dad.
"These kids were diagnosed when they were young, so the education was focused on the parents," Dr. Connor said. "Some have passed it onto the kids, but we want to make sure they have all the information they need to be healthy and safe when they're on their own for the first time."
That information can be generally characterized as decisions made within the competing boundaries of autonomy and responsibility. People with type I diabetes, for instance, have to "count carbs" to keep their blood sugar levels in their personal target ranges. That's pretty easy to do when mom is planning the breakfast, lunch and dinner menus. But what about when these kids are facing the smorgasbord of choices, healthy and not, in the college cafeteria?
"What can you eat on a college campus?" UW Health registered dietitian Cassie Vanderwall asked the course participants. "Anything. Everything. As much as you want. This new environment can set us on a path for healthful habits, or unhealthful habits."
Vanderwall outlined the parameters of a healthy meal plan, with an emphasis on fruits and vegetables, lean proteins, and "healthy" fats found in avocado, olives, nuts, seeds, and fatty fish like salmon. She also stressed the importance of snacking the right way, because college students often skip formal meals when time is tight.
For students who do not have diabetes, no dinner might just mean a growling stomach and ornery disposition. For those with diabetes, however, hunger can easily spark a "low" – a plunge in blood sugar that can result in headaches, blurry vision, shaking, sweating and fatigue.
"Our food environment can set us up for a series of lows, but quick carbs and refined sugars can be go-tos to get through the lows," Vanderwall said, recommending juice boxes, sports drinks, Jello® and applesauce packets as convenient fixes that can be stored in backpacks alongside books and papers.
Romero Rivera emphasized the importance of identifying on-campus resources that can assist during times of difficulty.
"Once you get on campus, look for the health office," she said. "Most campuses have staff that can help with minor illness and help guide you to other resources. Find your local pharmacy. Get prescriptions for all of your supplies. Get your clinic phone numbers."
Perhaps the greatest change the rising freshmen will experience is the availability of alcohol at college. Romero Rivera acknowledged that everyone in the room won't be old enough to legally drink when they arrive on campus, but she also knows most students become acquainted with the taste of beer during their freshmen years.
"Alcohol brings up a lot of questions," she said, warning that most pertinent amongst its many effects is its ability to inhibit the release of insulin. "You'll be at risk for low blood sugars, and it impairs your judgment, so you may not be able to recognize those low blood sugars."
Romero Rivera emphasized the easiest way to avoid the risks attendant to drinking is to avoid alcohol entirely, but she also offered strategies, like snacking before drinking and alternating alcoholic beverages with non-alcoholic beverages, to help minimize its impact.
No college student can prepare for everything their freshmen years have in store for them. But the information presented at the Diabetes College Course can reinforce the strategies they've already been employing.
"Most of them are already taking good care of themselves," Dr. Connor said. "They want a good college experience. They want to do what their friends do but also be healthy."
Date Published: 08/19/2015