As a recent college graduate, I can appreciate the beginning of the end of that first semester--no matter what year you're in. The light at the end of the tunnel can manifest itself in a first-year student's sigh of relief for having hit the halfway mark, or a senior's spidey senses picking up on the freedom brought by the holidays.
Winter breaks signify something else for students with type 1 diabetes: the mid-term checkup. I can still feel the sharp pangs of anxiety that haunted me when my thoughts turned to my A1C after that first semester in college. I dreaded my appointment with my diabetes team because I already felt like I had "failed" that test. Moving away for college is an adjustment for any student, but negotiating dining hall carb counting and coming down with the inevitable dorm-living illnesses made it much more challenging for me to take care of my diabetes.
Looking back, I wish I had asked for and received some different advice from my diabetes support team. Here are some tips for AADE members on counseling college freshmen during that winter break checkup:
1. Be sympathetic and understanding.
This may seem obvious, but a kind attitude can go a long way. Young adults with type 1 are constantly feeling as if they are being graded -- in class, at their jobs, and countless times a day when they test their blood sugar. I was very self-conscious about my diabetes when I first started college, and I judged myself to an unfair degree. I couldn't effectively communicate the challenges I was facing, so I had difficulty getting the help I needed to find solutions. If diabetes educators can understand the mindset of and pressure undergone by college students with diabetes, the chances of a healthy educator-patient relationship are much higher.
2. Shift the emphasis away from numbers.
If a patient's A1C isn't where it should be, focus on the steps that can be taken to fix it. Often, a focus on "good" and "bad" blood sugars is a reminder of lack of control, rather than an empowering tool. The diabetes educator can ask questions like:
How is the rest of your college life going?
Everyone knows that stress affects diabetes, so getting to know what else is going on in your patient's life is a good way to build open communication and target problem spots. Life isn't all about diabetes, so this is a key conversation starter during that first visit back from college.
Are you wearing a CGM? Introducing another helpful device may be a way to put the patient in more control of his or her diabetes.
Is (fun) exercise part of your routine?
Exercising can be more involved and social than just hitting the gym. Joining an intramural sports team can be a great way to alleviate stress and make friends (thereby managing blood sugar levels!).
3. Offer support.
If you're comfortable with it, perhaps you might allow your patient to contact you with any questions they have while they're away at college. Sometimes an avenue of communication can forestall future problems, like how to approach Hot Cookie Night or drinking alcohol. I texted my diabetes team when I wanted to raise my basal rates to combat the stress of exam week. It's a great feeling of relief to know your greatest resources are at your fingertips, even while you're a couple hundred miles away.
AADE members: What has been your experience working with college students over the holidays? Share your comments or suggestions!