Pizza, late-night study sessions and kegs full of cheap beer make college a challenging place for any student when it comes to maintaining healthy eating habits.
But for thousands of diabetic undergrads, the obstacles are even greater.
Foods high in fat and fructose can cause blood sugars to rise, and increased alcohol consumption can send glucose levels plummeting downward. As their peers navigate the cafeteria with relative abandon, diabetic students must count carbohydrates and adjust their medication to safely manage a chronic disease.
Staying healthy is "difficult for anybody, let alone a diabetic," said Brooke Wells Gunner, nutrition education coordinator at the University of Texas. "Not that it can't be done, it just takes some extra effort to be really motivated."
On some campuses, student organizations have risen to the challenge. One such organization is College Diabetes Network-Harvard, a support network comprised of students.
"The main motivation is wanting to feel good and live long," said Matthew Friendly, a Harvard senior and executive director of the group. Friendly is also a diabetic. "If I am feeling unhealthy, it affects my schoolwork, moods and energy levels."
Some schools are also taking steps to help out diabetic students like Friendly. While many university cafeterias still overflow with cheap eats and fried snacks, campuses including the University of Texas at Austin and Loyola Marymount University (LMU) in Los Angeles now offer online nutrition guides.
In addition, a few schools are using the Internet to make nutritionists more accessible for students. At LMU, students can chat with nutritionists online, schedule individual appointments and browse cafeteria menus for nutritional information.
But calorie-laden food is hardly the only threat that lurks on campuses for students with diabetes.
While alcohol consumption is known to be one of the largest health risks in general for undergraduates, a night at the bar poses an even higher risk for diabetics.
Alcohol can cause blood sugar levels to drop dramatically, while sugary mixers can raise glucose to unhealthy levels. To avoid this roller coaster, most doctors will advise patients to limit alcohol consumption — but for many college students, temptation and peer pressure make that order hard to follow.
"It would be wonderful if they didn't drink, but they will," said Andrew Drexler, an endocrinologist at UCLA. "The issue here is telling them how to get away with it."
Daniella Gilbert, another diabetic Harvard student and member of the university's College Diabetes Network, says drinking responsibly takes special effort.
"I always check my blood sugars semi-obsessively when I drink," she said, "and I try not to use juice as mixers."
What makes it especially important for diabetics to know the consequences of drinking is the fact that hypoglycemia can often be mistaken for drunkenness. As a result, others may not be able to distinguish a simple episode of inebriation from a medical emergency.
But as most know, eating together — and drinking together — is a large part of the college social scene. Diabetics may be left with the difficult choice of whether to put their social lives or their health at risk.