How to Navigate College with Type 1 Diabetes

Being away from home for the first time is challenging enough without throwing diabetes in the mix. Whether you’re newly diagnosed with T1D or have been dealing with diabetes since you were a toddler, lifestyle changes can hurl you into the great unknown.

When you consider all of the changes to your diet and exercise routine, then add the stress of finals and the temptation of alcohol, it can shock any young person’s system. But with the added pressure of diabetes, you have to worry about many other problems. The condition is not for the faint of heart. You must be on your toes, ready to catch all of the diabetes curve balls and throw them right back.

Here, University of Portland student Kate Cuadrado discusses the trials and tribulations of navigating university life, managing her type 1 diabetes, and transitioning from high school to college.

College and TID

Please tell us where you go to school, your year, major, and career aspirations:

Kate: I am a senior at the University of Portland, studying English with a minor in Ethnic Studies. I also work as the Editor-in-Chief for my University’s newspaper, The Beacon, and want to pursue a career in journalism after graduation. 

At what age were you diagnosed with T1D? Does anyone else in your family have it? 

Kate: I was diagnosed with T1D when I was seventeen, about three months before my eighteenth birthday. It was definitely a surprise because no one in my family has diabetes. 

Interesting Fact: According to the ADA's Diabetes Journals, over 90% of newly diagnosed type 1 diabetes cases have no family history. 

Do you have an insulin pump or do shots? Do you have a continuous glucose monitor (CGM)?  

Kate: I take my insulin with an insulin pen and have a Dexcom G7 that monitors my blood sugar. 

How were your parents when you left for college?

Kate: My mom was definitely anxious about me leaving for college. I had just been diagnosed a few months before school started and was still learning to manage my diabetes. She was scared that I would go low and not wake up to my alarm or be in a situation where I wouldn’t have snacks for low blood sugar or run into complications with pharmacies and insurance.

I reminded her that all these experiences she was potentially afraid of were situations I would need to go through to learn and understand my diagnosis. I think this eased her worry just a bit. I reminded her that this was a condition I would have for the rest of my life, and I was at a point where I needed to learn these things, and I needed to learn them on my own if I wanted to be able to handle my condition on my own for the rest of my life. I obviously had a lot of sympathy for her since it was all so new, and I would be moving over 900 miles away. Still, I let her know that I could handle it and that I needed to do this for my own journey. It helped to make her realize that she could feel okay with me leaving.  

How did you feel about starting college and moving away from home? Did your diabetes add a layer of anxiety?

Kate: I wasn’t really anxious about leaving for college and was more excited to leave my hometown (Thousand Oaks, California) after being cooped up during the pandemic. I was nervous about potentially being exposed to COVID since I would live in a more shared space in the dorms because I wasn’t sure what COVID-19 would be like now that I had diabetes. Luckily for me, however, no one in my dorm hall ever got COVID during that year!

Did you know your roommate(s) in the dorms? Did you tell them about being T1D?

Kate: I didn’t meet my roommate until we moved into our dorm together, but when I did, we became best friends almost immediately. I had told her I was diabetic over text before our meeting, and while moving in, I gave her the small rundown of things she needed to know, like how to use a glucagon kit in case of an emergency and what my low blood sugar alarm sounds like. Fun fact, we still live together in a house senior year and are still best friends — I don’t think I could have asked for a better freshman-year roommate! 

How soon after meeting someone do you tell them you’re T1D?

Kate: Telling people I have type one isn’t necessarily something I ever plan for, and I just wait until it comes up naturally. I take my insulin in a pen, so I have to inject it before every meal so most times, when I eat with other people, I’ll let them know right before I do it so they aren’t thrown off by me taking a shot. I’m the kind of person who thinks there shouldn’t be any stigma around type one or diabetes in general, so I’ll usually say something casual like, “I’m diabetic, so I’m going to take my insulin really quick,” before I take my shot.

Diabetes is part of my everyday life, whether I’m taking insulin before a meal or managing a low with some fruit snacks, so I often just go about my life until it’s relevant to mention to someone that I’m diabetic. Additionally, some people will figure it out themselves after seeing my Dexcom on my arm. 

You have a boyfriend now, but how do you navigate dating and diabetes? Do you tell them right away or wait until it’s serious?

Kate: Similar to telling anyone I have diabetes, I tend to wait until it’s relevant to mention. My boyfriend’s close childhood friend had diabetes and wears a Dexcom, so he recognized my device and knew I had diabetes without me really having to bring it up. Prior to my current boyfriend, I never really saw diabetes as an element of my romantic life and would simply let my date know I was diabetic if it was relevant to the situation (i.e., I go low during the date or were going out to eat and I have to take my insulin). 

I think that sometimes there can be a feeling of embarrassment when taking insulin or having a low during a date because of the idea that it’s not “normal” -- and anything “not normal” can feel embarrassing if you’re in a situation where you’re trying to impress someone. But as I’ve gotten older and more used to being diabetic, I’ve worked to push back against the idea that I should be embarrassed just because the way I live my life isn’t always the same as what someone expects. 

As for now and having a boyfriend while being diabetic, I find it really helpful to have someone who loves and cares about me and knows how to help me when I’m dealing with complications from diabetes. Just as with any good relationship, we care for one another — and him helping me when I’m low or supporting me when I’m dealing with something T1D-related is just an element of all the different ways he helps and cares about me.

Are you involved with clubs or extracurricular activities? How does stress play into your diabetes management?

Kate: I have worked for my University’s student newspaper for about three years and will be working next year as the publication’s Editor-in-Chief. It’s one of the most rewarding elements of being on campus for me — but I would be lying if I said diabetes hasn’t added to my stress when it comes to taking on some of my larger responsibilities.

Working on the paper is one of my favorite elements of my life, but it definitely comes with its fair share of stress, whether meeting deadlines, getting edits done, or tackling difficult stories. I know that I, especially, more than some other people, have to consider my stress due to my diabetes. There have been times when I’ve poured myself into my work because I want to do the best that I can, and in turn, I have disregarded my health and seen some dramatic ramifications.

Having diabetes will always be a learning curve, which can be frustrating at times, but at the same time, I know I need to pay attention to my health and slow down. You need to check in and act according to your body's needs. And it’s not just taking carbs to raise blood sugar. Things like stress, sickness, and even getting your period can come into play with blood sugar levels. Taking the time to lower my stress and take care of myself has been an albeit difficult lesson for me to learn, but a very important one regardless of whether I had diabetes or not. 

What was the most significant adjustment to college life? Did you have to readjust your insulin dosing, or was it relatively the same?

Kate: When I left for college, I had diabetes for about five months and was still taking a relatively low dosage of my long-acting insulin during my first semester away from home. However, toward the end of that semester, the “honeymoon phase” of being type one ended, and I suddenly had to triple my dosage to get the accurate amount finally.

Interesting Fact: A diabetes “honeymoon phase” is the period after a type 1 diabetes diagnosis when the pancreas still produces insulin. It can typically last a few months to a year post-diagnosis.

Kate: This was a difficult time as I suddenly saw my blood sugar stuck at nearly 300 for weeks, no matter what I did. I struggled a lot mentally, seeing my sugars that high when I thought I was doing everything right. When I learned I had to take a much higher dosage than I was used to, I felt feelings of failure even though I knew it was just what my body needed — this period of time taught me the importance of listening to what your body needs and not judging yourself for what you need to do to keep it healthy.

Whatever amount of insulin your body needs is the right amount, even if it feels like a lot or more than you thought you would ever need.

Leaving the honeymoon phase on my own and away from home was scary at first, but once I learned how my new normal and new dosing would work, I physically felt a lot better and eventually mentally felt a lot better, too. 

Would you say you’re open to questions if someone sees your Dexcom?

Kate: I’ve been really lucky to make some great friendships and connections with other students through both of us being T1D — I’ve even made friends through my Dexcom going off in class only for the person in front of me to whip around and excitedly ask, “are you diabetic too!?” 

Have you met other T1Ds at college or joined support or advocacy groups?

Kate: I think there’s a special bond between T1Ds in the sense that we can relate to each other on things that it sometimes feels like no one else can relate to. I have a great memory of spending hours (and I mean literal hours) with a girl from my English class just swapping diagnosis stories and talking about our frustrations and tips about being diabetic one evening after a class get-together.

Spending time with someone who truly understands what you’re going through and has been through is such a liberating experience.

I remember driving home that night feeling so light and thankful to have met someone I could finally talk about, anything and everything, diabetes. I tend to be a very independent person and like to deal with my problems on my own. I think for a while, I underestimated the power of having other people you can go to who, to an extent, understand what it’s like to live the same kind of life that you do. Obviously, every person’s story and journey with type one is different, but I really do believe that connecting with one another can make that journey just a little bit easier.

I’ve definitely had people ask about my Dexcom before (some more polite than others) and don’t mind answering questions about what it is, how it works, and why I need it. Sometimes I do have people who ask more follow-up questions about me being diabetic, and depending on who it is and my comfort level with them, I give as much information about my condition as I am comfortable with. I am open about being diabetic and wearing my diabetes gear openly and in full view, but that still doesn’t mean I owe strangers all of the answers to my life story, so figuring out what I am comfortable with and not comfortable with telling people is completely within my control and my right. Sometimes, I am willing to explain my story and other times, I am not, and both of those choices are valid. 

What do you always carry with you in your backpack?

Kate: Bag tour! Besides my phone, wallet, keys, and whatever crystal I want to carry around for the day (lately, it’s been sardonyx), my other essentials are my insulin pen, extra needles, one to two bags of fruit snacks (ideally two) and a glucagon emergency kit. For the glucagon kit, I keep one in my purse, one in my desk drawer at home, and one in my car to be prepared in an emergency. Additionally, and this isn’t really ‘in my bag,’ I wear a small medical bracelet on my right wrist that says “type 1 diabetic” in case I am in a situation where I am unable to tell medical professionals about my condition. 

What advice would you give an incoming first-year student with type 1 diabetes? Or someone newly diagnosed?

Kate: Goodness, where to start! I think I would tell them that you won’t always be in control of your diabetes, and that’s okay. There is no such thing as a perfect diabetic. College is fun and exciting and widely unpredictable — that’s some of the greatest parts about it!

There will be times when it feels like you’re doing everything right, yet everything seems to be going wrong, and it’s important to give yourself compassion so you can learn how to manage diabetes in a new place with new situations.

As someone who struggled a lot with giving up control in the months and even years following my diagnosis, I learned that treating myself with kindness and doing what I can to make sure I am as healthy as I can be given the situation was the best thing for me when handling my diabetes.

Giving up the idea of being perfect, especially in the context of one’s health, can feel really scary, but knowing that you are capable of handling the complications and giving yourself time and compassion for taking all of it on is essential to maintaining a healthy relationship with yourself and your diabetes.