Heading to College with Diabetes

Eating at a dining hall, partying with friends, moving into a dorm or apartment: college life is new territory for anyone who’s been growing up with diabetes. Because this transition away from home is an important milestone toward diabetes independence, it’s important to plan ahead.

“By the time a young adult goes to college, our goal is that we’ve provided them with the tools needed to make educated decisions, to navigate challenging situations, and to manage their diabetes successfully,” says diabetes educator Mary Farkouh, BSN, RN, RNC-NIC, who teaches a popular workshop at the Naomi Berrie Diabetes Center, called Taking Your Diabetes to College. 

Here, Mary answers questions that many of her college-age patients face, from how to navigate the cafeteria to how alcohol affects blood sugar.

Q: What do I need to know about drinking and T1D? 

A: While pointing out that the legal drinking age is 21, I am very honest with my patients. There will always be college-age kids who are drinking, and it’s important to understand that alcohol impairs the body’s ability to guard against hypoglycemia. Blood sugar will often rise after alcohol consumption and then decrease hours later.

Tell your friends you have diabetes because being low can look very similar to being drunk. Show your friends what they need to do in case of an emergency. Drink plenty of water. Before going out, have something to eat (or have snacks later with any drinks), leave glucose treatments by your bed (for when you get back), and remember to inject long-acting insulin if you use multiple daily injections. Avoid boxed wine, cider, mystery punches, or anything sweetened with sugary liquids. Know your blood sugar before you go to sleep for the night and wear a sensor.

Q: What are a few tips for getting my own groceries?

A: Suddenly, you have the independence to decide what and when you want to eat! Start by making an appointment with a registered dietitian specializing in diabetes (the Berrie Center has several), who can help you identify foods you like that will work with your diabetes and your budget. When grocery shopping, I tell patients to make a list and stick to it. Never go grocery shopping when you are hungry or have low blood sugar (because you’re more likely to grab less nutritious foods). It’s ok to buy treats but not in bulk. I also advise buying frozen fruits and veggies, which are easy, cheap, and just as healthy as fresh ones—and great for smoothies!

Q: What do I need to know about marijuana and T1D?

A: Marijuana indirectly affects blood sugars by impairing your ability to make smart decisions. We tell people not to smoke marijuana, but if they do, they need to realize they might make poor choices. We often see high blood sugars because people tend to eat more when they are high.

Q: How can I avoid the “Freshman 15”?

A: In general, the best way to avoid weight gain is to set a schedule and stick to it. Eat meals instead of grazing. At the dining hall, scope out all the stations before getting in line, focus on lower-carb options like salads and lean proteins that don’t cause a spike in blood sugar, and skip the fried foods. Also, notice non-hunger cues that motivate you to eat (like sadness, loneliness, stress, anxiety, anger, or boredom) then address that actual issue; remember food will not fix the feeling. Exercise—especially with a friend—can instead be extremely helpful in reducing anxiety, stress, and depression.

Q: Any tips on preparing for the unexpected?

A: No matter where you go, always have low blood sugar treatments on hand. If you are going to a party or a night out with friends, consider wearing an extra pump site or carrying an insulin pen as a backup in case your original pump site falls off. And, as always, wear a medical ID bracelet, set the health app/medical ID on your phone, or put an info card in your wallet to make sure any emergency personnel can easily identify that you have type 1 diabetes.

Q: What should I do if I get a cold or flu?

A: If you’re feeling sick—from nausea and vomiting to shortness of breath—don’t try to manage it alone. Call your parents and provider immediately and tell a friend you’re not feeling well. Continue taking your insulin, even if you are not eating. Stay hydrated, check your blood sugar every two to three hours, give corrections for elevated blood sugars, and check ketones. If you can’t keep fluids down, be prepared to go to a hospital. In case of illness, make sure you’re always stocked up on easy-to-eat foods, like sugar-free Jell-o, chicken broth, crackers, carbohydrate-containing beverages like Gatorade (for low blood sugar), and diet drinks (for high blood sugar).