Dealing with Diabetes in College

The day Yale senior Gabriel Betancur took the MCAT, the eight-hour medical school admission test, the sensor he wears taped to his arm to track his blood sugar levels sent data to his cellphone that showed his blood sugar was rising.

As anyone with type 1 diabetes knows, high blood sugar causes symptoms, including fatigue, thirst, and frequent urination.

“I powered through it,” says Betancur, adding that he might not advise someone else to try the same thing. “Maybe I should have taken the test on another day, but it all worked out.” Betancur passed the exam and was accepted at Yale School of Medicine; his dream is to become a pediatric endocrinologist.

It was a tough day, but nobody said higher education would be easy with type 1 diabetes. “We know, looking at the data, that achieving targeted glycemic control is difficult for many teens and young adults, and it’s a problem that can affect health long-term,” says Jennifer Sherr, MD, PhD, a Yale Medicine pediatric endocrinologist who is Betancur’s doctor and has type 1 diabetes herself. “Many studies are focused on how to improve care for this age group, in particular.”

Achieving targeted glycemic control is critical to prevent such long-term complications as cardiovascular disease, kidney disease, and retinopathy. Children up to age 18 are advised to target an A1c level (a 3-month measurement to estimate the average level of blood sugar) of < 7.5, and that should decrease to about 7 in adulthood.

Yet, the data from the Type 1 Diabetes Exchange Clinic Registry, a consortium of over 80 centers across the United States, shows that the average A1c in young people with diabetes (ages 13 to 26) is about 9, putting these teenagers and young adults at risk for complications later in life.

Betancur says it was a shock for his family when he developed severe stomach problems at the age of 4 and was diagnosed with type 1 diabetes. With this condition, the immune system mistakenly destroys the cells in the pancreas that produce insulin, the hormone that regulates glucose, or blood sugar. (This is different than type 2 diabetes, which is typically diagnosed in middle-aged or older people whose bodies don’t metabolize insulin properly.) Blood sugar is vital because it gives the body energy.

Because management of the disease is critical, it’s that much more complicated for students going off to college, who are away from their parents, the comforts of home, and even their doctors.

College students with type 1 diabetes must be prepared for their new environment, says Dr. Sherr: “They need equipment and supplies for injecting or pumping insulin. A refrigerator for storing it is mandatory, as are such items as juice boxes, glucose tablets, granola bars, and maybe some kid-sized candies for a boost when their blood sugar is low.”

Once college students are settled on campus, new triggers can drive their blood sugar levels too high or too low, putting them at risk for complications. They are faced with new eating and exercise routines, sleepless nights, late parties where alcohol is abundant, and a newfound sense of independence. “During adolescence, there may be a tendency to feel immortal,” says pediatric endocrinologist Ania Jastreboff, MD, PhD, who is also director of the Yale Obesity Research Center (Y-Weight).

Betancur, who was an undergraduate at Yale, thinks he managed the disease well in college, probably because he doesn’t remember life without it. But there were difficult times. “When you’re sleeping and don’t know your sugar is low, then you wake up, your heart is beating fast and you’re sweating—you think you are dying,” he says. Unlike at home, where his parents would go into his room and check his blood sugar while he was asleep, he was suddenly on his own.

Providers at the Yale Medicine Pediatric Diabetes Program at Yale New Haven Children’s Hospital schedule office visits for college-bound patients in the spring and again in August. Each May, they host a College Day for freshmen, their parents, and older peers like Betancur.

Participants submit questions anonymously: What if a roommate consumes all the snacks put aside in case of a hypoglycemic episode? (They could protect their food with a lock.) What if low blood sugar makes them feel sick during a final exam? (They should be aware of their rights under the American Disabilities Act, which includes the right to reschedule.)

“Our overall mantra is ‘be prepared,’” says Kate Weyman, an APRN and diabetes educator who coordinates College Day. “Know what you’re going to need, know your insulin doses and insulin pump failure plan, carry backup insulin and pump supplies, as well as something to treat low blood sugar at all times. You’re going to be OK, but you have to be prepared and responsible.”

There is light at the end of the tunnel, and it typically arrives at age 25 or 26—certainly by age 28, when insulin levels start leveling out, according to the Type 1 Diabetes Exchange Clinic Registry data.

Weyman, who helps young adults transition to adult care in a Type 1 Diabetes Bridge Transition Clinic, notes, “In my experience, for many patients after college something seems to click, where they realize they feel better if they do the things that help their blood sugar—as opposed to when they eat Lucky Charms and they don’t feel well,” she says.

One of Dr. Jastreboff’s patients is Michelle Slavin, who was diagnosed at age 13 and is now 29 and a nurse practitioner. She was determined not to let the disease hold her back in college. “I checked my blood sugar way more than is common. I’d have glucose tabs in my purse and ask friends to carry glucose tabs as well,” she says.

But toward the end of college, she was grappling with weight gain and subsequent disordered eating patterns, and she was angry—at diabetes.

Her nurse practitioner asked her to pick one thing she’d like to change about her disease. Slavin replied, “I wish I could exercise more.” After further discussion, she and her caregivers worked out a realistic plan that would reduce her hyperglycemia, giving her more freedom to be active. She has since run a half-marathon, a 10-mile race, and several 5Ks, and competes in Brazilian jujitsu.

“I think the most important thing for emerging young adults to know is that diabetes does not define them. That’s a critical point. They get to define who they are as individuals,” Dr. Jastreboff says.

Visit the Yale Medicine Diabetes Content Center for more diabetes-related articles and videos.