Alas, summer (and camp) is over and the newly graduated high school seniors are off to college. This is a big event for all family members, filled with emotion and, in many instances, terror (even for families without children with diabetes or other chronic illnesses). In addition to the usual separation anxiety and other concerns connected with moving away from home (perhaps for the first time), the family of a child with diabetes is faced with additional worries.
- Is my child going to attend to his diabetes self-care skills (without my constant reminders)?
- Is my child going to run out of medical supplies?
- Who is going to make sure that he is not low at 3 am?
- Who is going to make certain that lows are treated appropriately?
- Who is going to ensure that my kid gets up in the am?
- Is the student health center up to date with diabetes care?
- Do I need to find a diabetes specialist in the college town?
- How is my child going to carbohydrate count in college?
- What about experimentation with alcohol and recreational drugs?
- Have I left out any last minute advice?
Hopefully, your diabetes team has already addressed many of these concerns. During the senior year in high school, it is my usual practice to start requiring the adolescent to be more independent and interact with me at the visit instead of the parent. I try to have the parent wait in the waiting room while I conduct the visit with my patient. We address college related concerns including sex, drugs and, alcohol. And, I provide strategies if the young adult does (or plans to) experiment (only after I add the disclaimer that alcohol is illegal under the age of 21 and that recreational drugs are definitely ill-advised and outright dangerous.). So, what are the major questions and issues to be ironed out before and upon arrival to college?
1. Ensure that your college student has all supplies necessary for the semester and then triple the amount. You never know. The meter could be lost during rowing practice, the pump pod could be ripped out during the big football game, the insulin pump could be stolen, insulin vials smashed. (You get the picture).
2. Arrange to meet with the health team at the university just to inform them of your child's medical plan.
3. Consider contacting a diabetes specialist in the area, just in case. Our practice is to continue working with the student via phone and e-mail to perform insulin adjustments. However, if your child requires emergency treatment it is good to know the local medical facilities.
4. Make certain the dorm room has a refrigerator.
5. The college student should tell the roommate that he has diabetes and try to teach the most basic "survival skills" (what to do if he should go "low," etc.). However, my suggestion is that you do not overwhelm the roommate and leave most of the responsibility for your child's wellbeing to the Resident Advisor (R.A.). The R.A. needs more detailed information about emergency treatment and when to call 9ll. They also may want to ensure that your child woke up and went to classes in the am.
6. Reassure yourself (if you are the student) or your teen that the routine will be very different and insulin requirements will vary. Also food choices may be limited and that careful carb counting may even not account for those "hidden" carbs in college food. Don't be hard on yourself!!! Just check blood sugars more frequently and if on a basal/bolus regime, correct more frequently.
7. Now is the time to check more frequently, not less! You may be surprised...especially in view of different activity and food choices. So, carry your meter with you at all times.
8. Don't be shy about checking for ketones if you are high on two consecutive occasions. DKA is not fun in a strange city!
9. Be wary about drinking. Hypoglycemia and alcohol intoxication can look the same and your colleagues may just think you are drunk if you pass out after a party.
10. Enjoy the experience! This may be the first time that you and your family are apart. Isn't it great that no one is nagging you to check blood sugars? Isn't it fabulous that there is more flexibility in food choices?
The college experience is a wondrous opportunity for growth and independence.
JUST DO IT! (And be safe.)