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Managing Diabetes in College (September 2022)

Hello Mountaineers! I hope your first weeks of classes have been awesome and you are making new and fond memories! College can be an exciting time for many students, but it also can bring angst to others. It may seem overwhelming to adapt to the hustle and bustle of a college schedule while trying to plan your meals around what's offered in the dining halls and what you can eat between classes. And for someone dealing with diabetes mellitus, these could be crucial changes. You may have gone from planning and preparing your own meals to relying on whatever the dining halls offer. However, do not fear, this blog was written with you in mind to help navigate your diabetes in this new season of your life.

What is diabetes and why should I be concerned?

Approximately 37.3 million people have been diagnosed with diabetes in the U.S. That is every one in 10 U.S. adults that suffer from this condition. Even more alarming, approximately 96 million American adults have pre-diabetes 1. These numbers grow by 1.4 million people every year in the U.S. 2

Diabetes Mellitus is a chronic condition in which the body is in an altered state of using food for energy 3. Glucose (a sugar) is the bodies main source of energy and is a primary component of most foods, particularly carbohydrates. The body breaks down foods into glucose molecules to be released into the blood stream. In order for this sugar in the blood to be used for energy, it is picked up by a special hormone produced by the pancreas known as insulin. This hormone acts as a special key to the body’s cells to let glucose in and be utilized for energy. When this system is disrupted, it is classified as diabetes. However, there are a couple ways this system malfunctions, such as either the body is not producing enough insulin (type 1) or the body is not using insulin properly (type 2) to remove glucose from the blood stream, which can result in serious issues such as kidney disease, heart disease and vision loss 3. Diabetes can be diagnosed if A1C (glycated hemoglobin) levels are 6.5% or greater, when fasting blood glucose is 126mg/dl or greater, or when oral glucose tests hit 200mg/dl or greater 4. There are three types of diabetes that are categorized by the particular defect with insulin 3.

Type 1 diabetes (T1DM), also known as juvenile diabetes, is categorized as an autoimmune condition, meaning there is an immune reaction to insulin producing cells (beta cells) causing them to be destroyed so that the body cannot produce insulin 5. T1DM is genetically inherited at birth, but diagnosis can happen at any age. Since individuals with T1DM cannot produce insulin on their own, they are required to use insulin injections or an insulin pump as lifelong treatment to help control blood glucose levels.

Similarly, type 2 diabetics (T2DM) may need to take insulin to help prevent hyperglycemia (high blood sugar), but it is not needed unless disease progresses. In most cases, people with T2DM can control blood sugar levels by eating a balanced diet and exercise and in some cases taking diabetic medications such as Metformin (Bigaunide) 6. T2DM primarily differs from T1DM due to the fact that it is not an autoimmune condition and is characterized by insulin resistance. Insulin resistance means the body’s cells have stopped responding to insulin, thus they are resistant, and insulin is no longer being produced adequately to remove glucose from the blood. T2DM is the most common form of diabetes 7.

Oppositely, gestational diabetes is one of the least common forms of diabetes, as it only affects pregnant individuals. It typically is diagnosed around the 24th week of pregnancy. Due to changes in hormones and body weight when pregnant, the body might not produce enough insulin to remove blood glucose from the blood, causing the body to become insulin resistant. Gestational diabetes can lead to large birth weights, high blood pressure and premature birth. It is estimated that half of women with gestational diabetes develop T2DM after delivery 8. Like T2DM, gestational diabetes is primarily treated by medication and behavioral changes related to nourishment and movement 8.

All forms of diabetes are life-changing but can be successfully managed. Though they differ in diagnosis slightly, most experts agree that nutrition related factors and movement activities have large influences on the treatment and prevention for each type of diabetes 1-8. It is important to note that diabetes is largely influenced by genetic factors as well. That said, if you have been diagnosed with diabetes or pre-diabetes, you may be wondering what you can do, especially if you have just started college or have moved far from home. The good thing is that you have options at WVU and around Morgantown that can help. Let’s start with eating behaviors while in school.

Eating behaviors

Let's get one thing straight, diabetes does not mean you are stuck eating a boring or bland diet. It doesn’t mean you need to adopt a restrictive diet. Nor does it mean you can never have your favorite foods or desserts again; it just means a little planning is involved like checking your glucose levels. Nourishment or eating can be flavorful and exciting with a little experimentation. The best part is you do not even have to count, calculate or measure your food and calories. The American Diabetes Association (ADA) has come up with an easy eating format called the Plate Method in which half of a 9inch plate is non-starchy vegetables, ¼ of the plate is lean protein, and ¼ the plate is carbohydrates. Carbohydrates for the plate method are considered whole grain sources, starchy vegetables, legumes, dairy and fruits. The ADA recommends that people try to consume most fluid from non-sweetened beverages such as water, diet soda or unsweetened coffee or tea. It is important to remember that some foods can count as more than one food group and it is OK to consume those foods. For example, it is perfectly fine to eat pizza, which can count as a protein and carbohydrate; however it is important to eat this along with nutrient and fiber rich foods such as green leafy vegetables on the other half of our plate 9.

1: Nonstarchy Vegetables, 2:Protein Foods, 3:Carbohydrate Foods
The Diabetes Plate Method 10

If the plate method seems unappealing, there are other diets recommended for diabetes, such as the Mediterranean diet and the dietary approach to stop hypertension (DASH) diet that have been shown to help control blood glucose 9. However, do not think you must follow one particular style of eating to be successful at managing your diabetes. The basic concepts of eating to help with diabetes is including whole grain carbohydrates at every meal that are high in fiber. High fiber foods (>4g fiber per serving) help control hunger as well as slow down digestion to decrease blood sugar spikes 11. Additionally, whole grain carbohydrates are typically lower in sugars. Foods that are whole grains include brown rice, oatmeal, bulger, and 100% whole wheat breads and pastas. Along with a carbohydrate, every meal should contain a protein source (which can include plant-based proteins) such as dairy products, lean meats, nuts, tofu, tempeh and soy, etc. Finally, the premise for diabetic meals is that they are colorful and offer variety so that you are intaking plenty of vitamins, minerals, and antioxidants so try your best to consume 4-5 servings of fruit and vegetables a day 12.

Always remember that these are not strict guidelines; do not overwhelm yourself trying to do everything perfectly. Thankfully, the dining halls offer a multitude of healthy options to choose from, so be adventurous and try new foods that can fit in to your new style of eating. Also remember to keep healthy snacks on hand in case you have to go a long time without eating due to your busy college schedule. Apples with peanut butter, veggies and hummus, almonds, popcorn and edamame all are great quick snack options. It is important to not skip meals and snack when you are hungry. Your body knows best, so pay attention to hunger cues as this could be a sign your glucose levels are getting low. However, diet alone is only one part of the equation; living an active lifestyle is also important for managing diabetes.

Physical fitness

In addition to nutrition considerations, the ADA recommends individuals with diabetes strive for at least 150 minutes of moderate physical activity a week. Moderate activity means that you may be able to talk through your workout, but not bust out into song during it. According to the ADA, being active prevents hyperglycemia because it helps your muscles uptake glucose, removing it from the blood stream. Although 150 minutes of physical activity sounds like a lot, the good news is you can divide those minutes up depending on your personal schedule. For example, you could split 150 minutes apart by doing 50 minutes three times a week or 30 minutes five times a week. Also, your workouts do not have to be completed all at one time. You can break your workout into 10-minute intervals throughout the day! Fitting in your physical activity to what works for you and does not cause you anxiety is key to developing a lifelong routine. You do not have to stick to one particular routine. Do what you love, start out slow and take break days so you do not get burnt out on exercise. The ADA recommends taking breaks, but suggests you should try not to go more than 48 hours between exercise days so that your muscles stay in a constant state of glucose uptake 13. If you are a student at WVU, there are several classes at the Rec Center you can take if you prefer working out with others, as well as a swimming pool, a myriad of resistance and cardio equipment, and even trainers to help you along. Not to mention, the Rec Center has outdoor activities and outdoor rentals if you prefer to do things in the beautiful Mountain State. If doing activities in the great outdoors like walking or jogging interest you, the WVU campus and the bike trail by the river offer a great landscape for activity.

Small steps to managing diabetes

Diabetes can seem complicated and be initially overwhelming at first. However, it is important to not get overwhelmed by trying to perfectly alter your eating and activity habits. Rather, take small steps in making healthy lifestyle changes so that you can find out what works for you. One idea is to make a SMART goal every week or month and analyze how you have progressed. An example of a SMART goal is “replacing one sugar sweetened beverage a day with water.” This goal is small, but it is specific, measurable, attainable, relevant and timed (SMART) so you can be successful. In a matter, of time these SMART goals grow. And before we know it, we have completely changed undesirable habits. Often times, we try to make large goals for ourselves that seem out of reach and then we get agitated and give up when we do not hit those goals. So, let us start small in our diabetes management and be kind to ourselves, remembering that we are only human.

References

  1. CDC. The Facts, Stats, and Impacts of Diabetes [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Aug 29].
  2. Statistics About Diabetes | ADA [Internet]. [cited 2022 Aug 29]. Available from: https://diabetes.org/about-us/statistics/about-diabetes
  3. CDC. What is Diabetes? [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Aug 29]. Available from: https://www.cdc.gov/diabetes/basics/diabetes.html
  4. Diagnosis | ADA [Internet]. [cited 2022 Aug 29]. Available from: https://diabetes.org/diabetes/a1c/diagnosis
  5. What Causes Autoimmune Diabetes? :: Diabetes Education Online [Internet]. [cited 2022 Aug 29]. Available from: https://dtc.ucsf.edu/types-of-diabetes/type1/understanding-type-1-diabetes/autoimmunity/what-causes-autoimmune-diabetes/
  6. Insulin Routines | ADA [Internet]. [cited 2022 Aug 29]. Available from: https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-routines
  7. CDC. The Insulin Resistance–Diabetes Connection [Internet]. Centers for Disease Control and Prevention. 2019 [cited 2022 Aug 29]. Available from: https://www.cdc.gov/diabetes/basics/insulin-resistance.html
  8. CDC. Gestational Diabetes [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Aug 29]. Available from: https://www.cdc.gov/diabetes/basics/gestational.html
  9. http://www.intechnic.com I. What is the Diabetes Plate Method? [Internet]. Diabetes Food Hub. [cited 2022 Aug 29]. Available from: https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html
  10. Eating Well | ADA [Internet]. [cited 2022 Aug 29]. Available from: https://diabetes.org/healthy-living/recipes-nutrition/eating-well
  11. Stories DH. Can Whole Grains Help Prevent Type 2 Diabetes? [Internet]. Cleveland Clinic Newsroom. 2018 [cited 2022 Aug 29]. Available from: https://newsroom.clevelandclinic.org/2018/11/13/can-whole-grains-help-prevent-type-2-diabetes/
  12. CDC. Meal Planning [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Aug 29]. Available from: https://www.cdc.gov/diabetes/managing/eat-well/meal-plan-method.html
  13. Weekly Exercise Targets | ADA [Internet]. [cited 2022 Aug 29]. Available from: https://diabetes.org/healthy-living/fitness/weekly-exercise-targets

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