December 27, 2001
Other Social Issues
Question from Atlanta, Georgia, USA:
My 17 year old son, who has had type�1 diabetes since he was 13, will go away to college this coming fall, and I wondered if there are any advice books (for parents or teens) that deal with preparing young adults for the college experience or just being on their own. I worry about erratic schedules, eating (sometimes the dining halls are closed), drinking, etc. Perhaps you have other resources you could suggest. I am desperate!
I don’t know of any books that deal specifically with this theme over and above the information that most manuals for young people with diabetes already contain, but some of the bigger centers have one-day college bound workshops which would be helpful to enroll in, if you can track one down. In addition here are some preparations to make now:
You need to talk to your son’s present care team (and you may already have started this) about an insulin regimen such as bedtime Lantus (insulin glargine) with mealtime Humalog or Novolog based on carbohydrate counting. You and your son may also wish to consider use of an insulin pump which offers maximum flexibility. There would be plenty of time to get used to any change before college begins next fall.
Depending on the college, many students will at some stage elect to live off campus with friends, albeit not usually in their freshman year. For this reason, your son, who probably already knows quite a lot about conventional nutrition, also needs experience in buying food and cooking it which can be done at home.
Calculating the ‘carbs’ in cafeteria and other meals can be quickly done with the CalorieKing program downloaded onto a Palm Pilot.
It is important to make contact as early as possible with the college health service group, and if possible, to have your son’s diabetes team write to them about any special aspects of his care.
Vacations will be a good time to maintain contact with his home diabetes team and to get routine hemoglobin A1c and other needed testing done.
You also need to find out how students can access the Internet as this will facilitate non-urgent communication with home and the home care team.
Administrators who assign rooms and roommates need to know that your son has diabetes, and resident faculty as well as roommates need to understand about detection and management of hypoglycemia.
You and your son will also need to check or provide for (small refrigerator) storage space for supplies.
Additional comments from Dr. Jim Lane:
The American Diabetes Association has a series of publications for treatment of diabetes in young adults. As a practitioner treating young adults, I agree with you that this is an appropriate time for concern. It can also be a time to demonstrate autonomy and responsibility. First, I would look at the insulin regimen and see how it will perform if meal times are variable. If it won’t do well, consider another regimen with more flexibility. Involve your physician and diabetes education team. Learn nutrition. The irregular diet with high fat is a problem at college. Talk about alcohol. Talk about the risk of hypoglyemia with alcohol intake. It is only through realistic dialogue and good education that your son can put his refined self-care skills into action.