Dorm Life Diabetes

There's no textbook for adjusting to college life, and students with diabetes have a lot to learn.

By Owen C. Franklin

A great deal of college learning doesn't follow a lesson plan. Some students become thrifty home economists while shopping for ramen noodles. Others learn political skills while sweet-talking professors.

Maureen Reagan, a senior at Ohio State University, learned that a juice box can make a great alarm clock.

"My roommate would sometimes yell at me in the middle of the night and throw a juice box at me," said Reagan. "I'd wake up and she'd tell me I'd been sleeping weird."

For Reagan, "sleeping weird" means sleeping with low blood sugar. Reagan has type 1 diabetes, a disease that requires a strict regiment of meals, medicine and maintenance. But even this critical syllabus can fall apart when cafeteria food, fraternity parties and all-night study sessions take center stage.

The first months of college can be a precarious trial. This first taste of independence brings a great deal of freedom — and new responsibilities. When it comes to balancing stress, social life and class loads, some pass and others fail.

This test becomes critical for people with diabetes.

"For kids with diabetes, each one of these is a greater challenge," said Paul Madden of the Joslin Diabetes Center who heads up an education program called Life After High School. "If not handled reasonably, they could get into trouble pretty quickly."

Food plays a major role in both college life and diabetes — but the roles couldn't be further apart. Collegiate eating often involves haphazard meal times, unlimited portions and greasy choices. Diabetic eating requires schedules, rationing and careful attention to nutrition.

"In the morning, I had to make sure something was in my microfridge because nothing was open before eleven," said Reagan. "And if I wanted to have a pizza at midnight I would just say 'ok, whatever' and order out."

Students accustomed to parental "food watchdogs" may struggle to curb their cravings.

"Cafeteria eating can lack the structure that many people are used to," said Madden. "Instead of two slices of bread and butter they may have four. Instead of a bowl of ice cream they'll have an ice cream sundae."

If you ask students why they gorge themselves at the dessert bar, you'll probably hear a common answer: "Dude, I'm wigging out."

Stress runs rampant on campus. Term papers, all-night cramming and final exams can bury a student to the point of disorientation.

It can be hard to find a glucose monitor beneath a pile of textbooks.

"We see an increase in the number of people who have low blood sugars during final exam time," said Madden. "Kids get so focused on the exam that they don't eat enough or focus on their insulin."

Those late night study sessions don't help either.

"With decreased rest, a person with diabetes is more susceptible to unexpected low blood sugar," said Madden. "You tend to miss the symptoms if you're too tired."

As most students know, there's more than one type of all-nighter in the ivory tower. A typical Friday night can lead well into Saturday morning on fraternity row. Many students pass these hours with a beer or two (or more) to forget about monstrous professors and social anxiety.

Sometimes, insulin shots take a backseat to shots of tequila.

"If the kids are drinking, they may forget when they took their last shot or when to take their next," said Madden. "And if they do remember, will they anticipate what the drugs or alcohol are doing to their blood sugar levels? Plus, it's harder to recognize the symptoms of low blood sugar when you've had drugs or alcohol."

And the risks don't end when the kegs are kicked. A "crashed out" college student may be just another casualty of dormitory living, but it's also a red flag in diabetes management.

The liver produces a certain amount of glucose during sleep. However, if there is alcohol running through the bloodstream, the liver will work to filter out the alcohol and be unable to produce glucose.

"If all of a sudden you don't have the glucose you normally do, you could have some trouble," said Madden.

While negotiating classes, insulin, parties, glucose tests, social pressures and diet can prove a difficult challenge, it needn't be surmounted alone. When it comes to diabetes management, there really is safety in numbers.

"It's worth talking over with the school's health advisors before going off to college," said Matthew Riddle, M.D., professor of medicine and diabetes specialist at Oregon Health Sciences University. "After they get there, they're going to have to find a new support system."

This system needs trained medical professionals such as an endocrinologist or a diabetes educator. However, the most important role in this team may be a lab partner or the freshman next door. Recruiting teammates may require some courage.

"There's a very strong wish to fit in, and kids who regard their diabetes as abnormal or as a secret are going to have trouble," said Dr. Riddle. "It's really important for a person with diabetes to be able to count on a friend to run and get them some fruit juice."

Most students don't figure out the secret to college living in the first semester. It takes time to sever home ties, settle in and find the closest all night copying store.

The same learning curve applies to students with diabetes.

"After the first year of college, students are usually doing better with their diabetes than ever before," said Dr. Riddle. "I think the experience of going away to school and being on your own is a good experience in general, it helps people grow. I think this works the same way for diabetes."