I am seventeen years old, and have had diabetes for four years. I will be graduating from high school in a couple of months and going to college in California. My diabetes isn’t under the best control, but it is a constant process to bring my hemoglobin A1c down. So being away from my family and friends is already going to create stress, and I don’t need any added stress from my diabetes. Do you have any tips for surviving college with diabetes and possibly getting my A1c more in control while away from home?

Although I don’t have “magic answers”, I usually recommend the following to teens going to college:

Get a refrigerator in your room so you can stalk up on emergency food in case you oversleep or don’t have time to go to the cafeteria, or are low. If your dorm doesn’t allow refrigerators, ask your doctor to write you a letter asking for an exception. Keep a supply of food in your room that won’t spoil — breakfast cereals, vacuum packed cartons of milk that last longer and don’t even need refrigeration, “single portion”, individually wrapped snacks, “quickie meals” such as bars that are a combination of protein and carbohydrate, and emergency food for low blood sugars.
If you are on a meal plan, see if you can talk to the people who plan the meals. Many freshman females without diabetes gain a lot of weight eating the high carbohydrate foods served on meal plans. Often there are “hidden” carbs in the food such as cornstarch. See if you can find out which foods have hidden carbs so you can either avoid them or least keep track of the carbs. See if there are certain foods always available if what they are serving that day doesn’t fit into your meal plan. Beware the pasta dishes and pizza — it’s easy to “overdose” on carbs and potential for a lot of “hidden carbs” and often high in fat.
Be prepared for unexpected lows. Keep a Glucagon Emergency Kit in your room and make sure someone knows where it is or even better someone else has another glucagon kit for emergencies and knows how to give it or at least knows to give it to emergency medical help that may come in an emergency. Keep in mind that you may be more active at school than at home if you have to walk long distances between classes or live on an upper floor in a dorm without an elevator. If you develop a stomach virus and start to go low and can’t keep food down, talk to your doctor about giving a small dose of glucagon yourself to prevent a serious low blood sugar. (Most stomach viruses cause high blood sugars and you may need extra insulin, but sometimes, the opposite occurs and you can’t keep food down to bring up the blood sugar.)
I think it is a good idea to have a roommate at least the first year in case you have a serious low blood sugar during the night, someone is around to help.
Even if you are on a “flexible” schedule such as taking insulin every time you eat and varying the insulin according to how much you eat, or using an insulin pump, I would recommend at least the first month trying to be more consistent in the times you eat and the amount you eat to establish a new “average” insulin dose on your new schedule and new foods. Once you have re-established a new average insulin regimen, you can experiment with changing the timing and amount of food and adjusting your insulin.
Try to get daily exercise, if possible at the same time of day. It will help you relax, study better, and will help keep your blood sugars under better control. Most schools have gyms or pools where you can exercise even in bad weather, or take up a sport for fun.
Try to stay away from alcohol. I know at many college campuses there is a lot of pressure to drink even if it is “underage” drinking. Even though in moderation, “social” drinking can be worked into the meal plan, most college students do not drink in moderation, and tend to drink beer which is high in calories and carbohydrate and will raise the blood sugar and put on weight. (Pure alcohol, like rum and gin, put on weight, but don’t raise the blood sugar.) In fact, alcohol itself may prevent the body from pulling sugar out of the liver to prevent a low blood sugar especially if you drink on an empty stomach and increase the risk of serious low blood sugars.). If you mix pure alcohol with a carb such as OJ or real Coke, then of course the carb in the OJ or real Coke will work to raise the blood sugar. Remember, if you do drink, don’t drink on an empty stomach, and one glass (even a small glass) can last the entire evening if you “sip” it and don’t constantly refill it!
Keep in touch with your endocrinologist at home, or if that is not possible, see if you can see someone near your school. Just keeping records of your blood sugars and insulin doses tends to improve control as you tend to work harder at it if you are keeping records to show to your doctor. Perhaps your doctor would allow you to e-mail your blood sugars from school to help you adjust them in the first few weeks when everything is changing.
Try to just do your best and try not to get frustrated, upset or mad at yourself if your blood sugars aren’t as good as you would like. Remember, we still aren’t as good as a real pancreas and it’s not your fault you have diabetes. Expect things to be different and have a plan in place ahead of time to work with a physician to help you make adjustments. Keep in touch with your family. They will miss you too and want to help.
Study hard, work hard, take care of yourself, and try to have a great time!

TGL

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