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.
Alcohol a Special Danger
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.
Finding Support Is Key
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.
"Instances occur almost every week when a group of friends will be ordering pizza at a time when I am unable to eat, and I am forced into either eating the pizza or leaving friends to avoid [food] that will spike my blood sugar," Friendly said.
The good news is that diabetic students can often find support through online social networking sites like Facebook, which boasts more than 500 groups dedicates to diabetes.
Other students like Gilbert and Friendly support each other through campus clubs.
"It was really nice to be able to take out my blood meter and test [my glucose level] without people looking at me or pretending not to look at me," Gilbert said.
"The idea," added Friendly, "was that having support from those around you going through the same daily struggles makes the challenges of diabetes a lot easier to get through."
Making the Transition
Such support may be crucial — particularly considering the fact that before college, most students' parents are responsible for shopping and managing food preparation in their households.
"The most challenging part of the transition [is] having to make those choices myself," Gilbert said.
"[Diabetics] give up control of how food is prepared when [they] are in a cafeteria, and that can be very frustrating," said Stacey Snelling, associate professor of education, teaching and health at American University in Washington, D.C.
While some students may become overly cautious in their food choices, others may rebel against their normally strict diets, putting themselves in danger.
"The challenge is that everything looks good in the cafeteria," Snelling said. But she adds that there are ways to deal with the temptation.
For example, she notes, "pizza is a fine food [and] it's not so problematic if you balance it out with other foods," like a salad or fruit.
And other features of campus life may add to the difficulty of the transition from home. Snelling and Drexler agree that busy schedules cause many diabetic students to eat at irregular times.
In addition, even getting used to walking the grounds of a large campus can be an adjustment.
"They are accumulating more exercise — and their blood sugars fluctuate more so than they did in high school."
To help combat the obstacles diabetics face on campus, organizations like The American Diabetes Association and others provide valuable nutrition tips online.
The overall rule of thumb is to incorporate a lot of variety, whole grains and protein into meals. The University of Texas' Wells Gunner suggests that students substitute processed grain products like white bread and pasta with whole grain options instead.
Gilbert agrees that having these foods on hand is a huge help for her. "Having healthier snacks in my [dorm] room is enough to keep me from going to get a burrito or pizza at one in the morning."
Juice boxes, hard candies and fresh fruit can be good choices for combating low blood sugars. In dorms with little more than a mini-fridge, these are good choices because they can be kept at room temperature and easily tossed into a backpack before class.
And even on a college campus, following a diabetic diet can be easier and more widely accepted than many think.
"Everyone can benefit from eating like a diabetic," said Wells Gunner. "It can be a very healthy diet because it's balanced."