After High School (Teens)
So you’re planning on going off to college or starting a new job or training program! It’s a brand new year and everything is different...but don’t neglect your diabetes management! No need to be afraid, the U-M Pediatric Diabetes Team is here to help you along your journey. This next part of life after high school is going to be a blast and diabetes doesn’t have to be daunting or impossible. Your parents may be freaking out, but many patients have been in the same boat as you. Here are some practical tips for when you set sail.
If they have not already, it may help your parents to read through: After High School (Parents).
Much of this information can be found in College Diabetes Network’s “Off to College: For Students” resource which can be requested online here or picked up as a booklet upon request at our clinic.
One of the biggest similarities between college and diabetes is the cost. Luckily, there are a few scholarship opportunities specifically made for patients with diabetes! Check out this list of scholarships compiled by College Diabetes Network. Check back periodically, as several of these opportunities will open up later in the year.
Registering Your Diagnosis
It is important that your diagnosis be on record with your college or university. Once you have committed to the school you plan to attend, have your parent or caregiver help you contact their student services or student disabilities office (schools have different offices that handle this) and request to register a disability diagnosis with them. They may have a form(s) for you to sign, and for the medical team to sign off on, and/or we have a form letter that we can provide which verifies your diagnosis and gives an overview of your regimen and requested housing and testing accommodations - just ask your team!
College = Freedom
One of the great things about college is the ability for you to make your own schedule. What this means for diabetes is that you often lose the routine and structure that you had around your regimen in high school, where your days were roughly the same and you had more consistency in when, where and how you checked blood sugar, dosed insulin etc.
Now, you may find yourself sleeping in late some days and having early classes on others; staying up late to cram for exams or go out with friends; walking miles around campus or napping all day in your dorm; anything can change on any given day. Diabetes is a challenging condition to handle in any setting, but if you find that college life is making it harder to stay on track, you are not alone! You may want to look over your schedule and plan ahead time for your meals, blood sugar checks, and insulin dosing to help prevent last minute stress. Reach out to your family and care team to discuss ways to make this easier, and maybe adapt your regimen to better fit your new life.
Dining Hall Dilemmas
When you’re in college, you’ll notice people eating ALL the time. A good piece of advice is to stick to an eating routine - eat at the same time each day to avoid preventable highs and lows.
An especially popular past-time in college is eating pizza late at night. If you’ve ever eaten pizza late at night, you probably know it’s a nightmare for your blood sugars -- all those carbs and fat digesting while your body is trying to rest can cause chaos -- and it almost always ends with sky-high blood sugars when you wake up. Try to avoid this situation as much as possible, but if it does happen, just make sure you cover the carbs carefully. Certified diabetes educator Gary Scheiner recommends delaying your bolus to wait for the pizza to digest a bit and covering the fat from the cheese with extra basal or an extra injection of short acting insulin. Check out his thoughts on the “pizza problem.”
What Should I Pack?
Depending on your personality, you may be stressing or jumping for joy thinking about all the things you will need to bring to college. A TV, a comfy couch, some string lights to hang on your ceiling...sounds great, right? Don't forget, with T1D, there are other things you should consider adding to the list. A mini-fridge for storing insulin and a sick day box can be as vital as bringing your meter and other testing supplies. Some potential things to include might be ibuprofen, cough drops, a thermometer, heating pad, microwaveable soup, ginger ale or cola, your care team's emergency numbers, and of course: glucagon. It's better to have these supplies on hand so you don't need to leave your dorm when you're feeling down.
You will also want to pack enough supplies to last through vacations if you won't be traveling home for the break.
Having "the talk" with new friends
You may be concerned about telling any of your new friends and roommates about your diabetes in a way that won’t worry or scare them. The easiest way to tell them is by starting simple and being confident and comfortable in what you’re telling them. The more people that know about your disease (now that mom and dad aren’t here), the safer you will be in case of a low or other emergency. You may also find that opening up about something personal can lead to more meaningful friendships as others will recognize your efforts and respond with their own vulnerabilities. For help with having “the talk,” check out this guide from College Diabetes Network.
The first people you should tell are your roommate and the Residential Advisor (RA) for the hall - they will need to know how to use glucagon, what your highs and lows look like, and why you’re keeping special vials in your fridge. If you have a communal fridge for the whole dorm floor, we’d recommend getting your own college-sized fridge to store not only your insulin, but also sodas/juice/snacks for yourself (which is a huge benefit in a college environment).
You should also consider telling your professors at the beginning of the semester - especially professors and teaching assistants in small classes where taking care of diabetes may cause a disturbance or be noticed.
This Meter's Made for Walking
While living at home, maybe you drove a car or rode a bus to school. It’s easy to know how far you have to go to get from place to place. When you’re in college, most first year students only have their two feet to get them where they need to go. This can mean walking for a mile or more over the course of a day, depending on where your classes are located and how many trips you have.
When you leave the dorm room, assume you may not be back there until after dinner and plan accordingly. That means, do your set changes/CGM changes before heading out the door if you know they will expire soon. Make some time in your schedule for a snack or lunch and definitely keep some type of sugar with you in your backpack before walking out the door to avoid lows during the day. If you don’t have a medical ID bracelet, now may be a good time to get one since the majority of people around you won’t know you or how to take care of you in the case of an emergency.
If you are one of the lucky ones who will be driving around campus, take extra caution before you get behind the wheel. Check your blood sugar before you go and make sure you won't be going low while you're out. Make sure to have snacks handy in the glove compartment or in your bag. All these driving tips can feel like a lot to remember, but don't forget to buckle up as well!
Many young adults think of college as a place to explore. A lot of college-aged people may invite or pressure you to drink alcohol. It’s important to be able to say no when you are uncomfortable with the situation, but it is also important to know we want you to be safe and responsible. You can reach out to your care team confidentially if you have concerns about drinking.
You should also know this: alcohol is unpredictable. Some people process alcohol more slowly than others. And alcohol metabolism can depend on several factors like the amount of alcohol consumed and over what time period, your height and weight, the type and amount of food eaten before and while drinking, and your level of physical activity. Many people experience lows hours after drinking alcohol or engaging in physical activity like dancing.
Be aware that blood sugars react differently with each person and alcohol. Before you go to sleep, check your blood sugar and have a snack. Setting an alarm to wake up to test your blood sugar during the night can prevent a dangerous low. Glucagon will not help treat alcohol-induced hypoglycemia in the event of an emergency. Most importantly, you should have someone available who can look after you and call in case of an emergency. Remember, a low can look a lot like being drunk and if nobody knows any better, they won’t be able to help you treat it.
DrinkingWithDiabetes.com is a helpful resource for patients and those who want to learn more about drinking safely and responsibly with T1D.
While you are at college, you may experiment with dating and sex. This is normal behavior for young adults -- chances are, your college can and will offer you specific resources regarding safe sex and consent. For young adults with T1D, relationships can come with an extra set of baggage that your partner may not know how to handle. You may not even be aware how your T1D will react to sexual situations yet. It may also be difficult for you to determine how involved your partner should be in your T1D care. Your needs are unique, and that’s perfectly okay. Check out this guide from Beyond Type 1 on how to introduce diabetes into a new relationship or share the Boyfriend/Girlfriend T1D Guide with them.
If you need to talk to your care team about relationship troubles or sexual health, you can do so confidentially. In addition, you can contact us to help educate any relationship partner who has an interest in learning about and caring for T1D.