College Bound With Type 1 Diabetes
By Toby Smithson, RDN, LDN, CDE
As a nutrition professional, if you’ve ever had the opportunity to counsel teenage patients with type 1 diabetes who are about to go to college, you know how unsettling a time this can be for them and their families.
Even if you’re about to counsel an anxious incoming freshman for the first time, know that you can have a powerful influence on his or her health behaviors by helping the student make this critical transition to independence a positive one. No matter what level of support and supervision families have provided their college bound teens until now, it’s time for these young adults to take the reins and manage their disease successfully on their own.
Review the Basics
College life likely will be the ultimate stress test for diabetes self-management, so it’s important to discuss the unique challenges young patients will encounter regarding food selection, fatigue, and social activities. However, it’s best to begin by reviewing the basics of diabetes self-management.
If you’ve been counseling a particular patient regularly, you already may know to what extent he or she understands and manages food intake and insulin dosing, but it’s worth giving a review. Knowing how to count carbohydrates and administer the correct insulin dose with a meal is as basic as it gets, but you may be surprised to find that your patient guesses most of the time. Learning how to calculate carbohydrate and insulin intake is especially important for patients who don’t routinely wear a continuous glucose monitor (CGM) because follow-up blood glucose testing with a finger prick is something most people with diabetes like to avoid.
Selecting the appropriate foods to eat can be a challenge for young patients living on campus, so help them develop strategies to eat healthful foods. Will the campus meal plan include regular, healthful meals? What local or popular restaurants around campus offer the best choices? Will the dorm room have a refrigerator and microwave, giving a student the opportunity to prepare healthier options? These are just a few suggestions that can encourage young patients to think strategically about diabetes self-management.
Another facet of diabetes self-care is regular physical activity, which can help stabilize blood glucose levels long term. Many university campuses have fully equipped fitness centers for students that include treadmills, elliptical trainers, stair climbers, stationary bikes, free weights, and strength training equipment. Many also offer a variety of aerobics classes throughout the week. So encourage patients to engage in a minimum of 30 minutes of moderate exercise five days per week or 90 minutes of vigorous exercise three days per week.
In addition to developing strategies for patients to eat healthfully and exercise regularly, suggest they ask about medical services on campus. Are RDs or CDEs available to provide nutrition counseling? Is there a student diabetes support group? A support group can benefit incoming students because the social aspects of diabetes among teens can positively influence routine self-care and even help them avoid serious emergencies. If there are no diabetes support groups on campus, students can contact the College Diabetes Network (www.collegediabetesnetwork.org), a national nonprofit organization whose mission is to empower and improve the lives of students living with type 1 diabetes through peer support and access to information and resources.
In general, today’s young people are open about having diabetes, but openness isn’t enough. Patients need to feel comfortable with new friends and be able to depend on them to help recognize and resolve potential emergencies, such as detecting signs of severe hypoglycemia. The behavior changes associated with extremely low blood glucose levels, which are different for every individual, often are more recognizable to others than to patients. Sometimes hypoglycemic individuals need convincing that there may, in fact, be a problem. So discussing the importance of feeling comfortable enough to depend on others during this time of independence will do them a great service.
With your guidance, less-than-ideal food choices, random eating schedules, stress, fatigue, lack of sleep, and inconsistent blood glucose management practices will resolve themselves.
Moreover, having a firm discussion about alcohol drinking is imperative. In fact, it can be lifesaving because mixing alcohol and diabetes can be deadly.
Drinking alcohol interferes with the body’s ability to balance blood glucose levels by co-opting liver function for alcohol metabolism. And even though carbohydrate-containing beverages or foods may be consumed, in a counterintuitive way alcohol consumption can lead to severe hypoglycemia by depressing the breakdown of glycogen stored in liver cells when glucose is necessary to raise declining blood glucose levels. Alcohol-induced hypoglycemia is particularly dangerous because the symptoms can be identical to alcohol intoxication and not readily recognized when alcohol is being consumed in excess.
Share the following tips regarding alcohol consumption:
- Avoid drinking excessively. One drink per hour is enough.
- Drink alcohol with food, and stay hydrated by drinking plenty of water.
- Test or monitor blood glucose frequently, even overnight and into the next day.
- Don’t depend on friends who also are drinking to be responsible for the student with type 1 diabetes.
- Wear medical identification at all times.
Making the Transition
Going to college is an important milestone and transition into the next phase of adult life. It’s also an important transition into becoming solely responsible for diabetes self-management. For dietitians, it’s an opportunity to launch a young person on the right trajectory into a lifetime of good health.
— Toby Smithson, RDN, LDN, CDE, is a national spokesperson for the Academy of Nutrition and Dietetics. She’s the founder of DiabetesEveryDay.com and a coauthor of Diabetes Meal Planning and Nutrition for Dummies.