Touchy Topics

A comprehensive guide to all the sticky situations that arise when you’re a college student with diabetes. Have a question that isn't answered here? Ask us (anonymously) and we'll get it answered for you.

 

  Alcohol

Drinking? Know the facts.
 

  Girl Stuff

Anything and everything related to being a girl with diabetes.
 

  Guy Stuff

The good, the bad, and the ugly of being a guy with diabetes.
 

  Celiac Disease

       Type 1 diabetes is sometimes linked to another autoimmune disease called Celiac Disease.

  Drugs

Learn the facts. Stay safe.
 

  Eating Disorders

Think you may be affected by an eating disorder? Learn more here.
 
Let's face it: diabetes is a bummer sometimes. 
 
 
 

 

Alcohol

It’s no surprise that drinking happens on campuses all over the country. If you plan on drinking while at school, make sure you understand how to do it safely with diabetes. Check out our FAQ below, which includes many of the common questions young adults have regarding drinking, and make sure to check out our partners at Drinking with Diabetes for additional information.

FAQs

We know it’s hard to bring up certain questions in the doctor’s office. But often, the hard questions are the ones we most need answers to. Below is an exhaustive list of questions you might be thinking about, but may or may not have asked a healthcare professional. If your question isn’t here, we’re happy to help – send it along, and we’ll get it answered. 

The information below is not meant to replace the advice of your healthcare team. Individual responses to diabetes management approaches can vary considerably. Speak with your physician before making any changes to your therapy.

Integrated Diabetes Services  Answers courtesy of Gary Scheiner MS (T1D since 1985!), CDE and his team at IDS.

How can I tell the difference between being low and being drunk? And being low while drunk?

Being drunk and being low can look the same. And both conditions can severely impair your judgment as well as your ability to function. Intoxication, however, does not usually cause the “shaking/sweating/rapid heartbeat” associated with hypoglycemia. Unfortunately, drinking can actually suppress these symptoms. The only way to know for sure is to do a BG check. And it is certainly possible to be hypoglycemic and intoxicated at the same time. In fact, alcohol tends to reduce the liver’s output of glucose hours after the alcohol is consumed, which can make blood sugar drop.

To stay safe:
  • Check your BG frequently when drinking. This is the best way to keep yourself clear of danger and learn how different types of drinks affect you, keeping in mind that the impact can last into the next day.
  • Wear diabetes identification at all times. It should be conspicuous enough that a first responder will not overlook it. Don’t rely on a wallet card, or even on wearing an insulin pump. A “Medic Alert” necklace or bracelet is optimal.
  • Make sure that the friends you are with know what hypoglycemia is and how to treat it…and that an appropriate treatment is readily available. Keep some glucose tablets or sweet candy on hand.
  • Don’t drink on an empty stomach, as this can cause more severe intoxication and hypoglycemia. Also, if you plan to be dancing or walking a great deal, plan accordingly with a reduction in your insulin or compensatory snacks. 

What should I do if I throw up after drinking?

Drinking too much or having unusual combinations of alcoholic drinks can produce nausea and vomiting. This can cause blood sugar to drop, as food eaten previously may not have an opportunity to absorb into the bloodstream before being vomited. Check your blood sugar at least once an hour for several hours. Drink non-alcoholic beverages to rehydrate yourself, and take in some light carbohydrates (crackers, cereal, bread, sports drinks) to keep your blood sugar stable. Wait until 15-20 minutes after eating before taking insulin just to make sure the food stays down. If hypoglycemia occurs and your stomach is too upset to keep food down, you may need to give yourself an injection of glucagon. Inject the fluid into the glucagon vial, shake the vial, and then draw out 20-30 units with an insulin syringe. Inject the glucagon into the fatty layer on your abdomen, similarly to the way you would inject insulin. You may repeat the injection if your blood sugar does not rise within 20 minutes. Of course, if nothing seems to be working, or you don’t feel that you can deal with the situation, call 911. Paramedics can easily administer dextrose through an IV. This is guaranteed to bring your blood sugar back up very quickly.

Sometimes when I go out drinking, my blood sugar winds up really high. What’s the best way to deal with a high after drinking?

When drinking alcohol, the body may become dehydrated. This can make it harder than usual to bring a high BG down. Besides giving insulin to correct the high reading, try to drink water or electrolyte beverages that have low or NO carbs (something like Propel, Powerade Zero or Vitamin Water Zero). After giving insulin to correct a high, check your BG again in 60-90 minutes to ensure it is coming down. If it isn’t, drink more carb-free beverages. If your BG is still elevated 3-4 hours later, give another correction dose. Stacking insulin too closer together can cause a nasty low BG hours later. And don’t forget… alcohol can lower blood sugar hours after it is consumed. Any “correction doses” of insulin should be taken with extreme caution to prevent hypoglycemia.

What should I expect the morning after drinking?

Consuming small amounts of alcohol (1 or 2 drinks) usually produces no unusual symptoms the next day. Drinking larger amounts at one time can cause headache, dry mouth, fatigue and lower-than-usual blood sugar levels the next day (aka a hangover!). To minimize these symptoms, drink plenty fluids and eat regular carb-containing meals the day after a night out. Check your blood sugar more often than usual so that minor highs and lows can be corrected before they become severe. Note: If you choose to take pain medicine the day after drinking, check the label for acetaminophen if you use a Dexcom CGM. Acetaminophen causes the Dexcom to read inaccurately high for several hours. 

How long after drinking can it affect your blood sugar?

The carbs in most drinks (including beer, sweet wine, and mixed drinks) tend to raise the blood sugar quickly – within an hour in most cases. Giving rapid-acting insulin for the carbs will help prevent a sharp rise in blood sugar.
The alcohol can cause a gradual reduction in blood sugar well into the next day. In general, the more drinks you have, the less your “tolerance” for alcohol, and the less you weigh, the longer the effect will last. Plan to check your BG’s more frequently the day after drinking to evaluate its effect on your control for future reference.

Someone told me I shouldn’t exercise the day after drinking. Is that true? 

If you have enough energy to exercise after a night out with alcohol, it is usually fine to do so. Best to wait until later the next day to ensure the alcohol from the night before is no longer affecting your blood sugar. And best to stick with a workout you’re used to. Try not to do anything more strenuous than usual, as your body’s energy stores may be compromised the day after drinking.

Is it a good idea to eat while drinking?  If so, what is best to have?

Alcohol is better tolerated with food in the stomach regardless of the type of alcoholic beverage. Try to have drinks with a meal or with snacks that include a bit of fat and protein (chips w/dip, cheese, nuts, etc.) That way, the food will have a more lasting affect through the night, and will help protect you from hypoglycemia while you sleep.

Does drinking mess up a continuous glucose monitor?

Alcohol itself should not affect the accuracy of a CGM (unlike acetaminophen*, which does affect some systems.) In fact, using a CGM is a great way to keep yourself out of harms way when you drink. Pay attention to the trend lines and high/low alerts after consuming alcohol. Knowing where your BG is headed is just as important as knowing where it is. And don’t forget to calibrate your CGM before you go out drinking – you may have other things on your mind later that night! Acetaminophen is found in all “Tylenol” products as well as many prescription and over-the-counter medications used to treat colds, flu, fever, aches & pains. Check the ingredient list on all medications to see if they contain acetaminophen.
 

 

Girl Stuff

Women, unfortunately, aren’t exempt from these types of problems either. Here’s information on some of the most common problems in women that are associated with diabetes, as well as some solutions.

Vaginal dryness and decreased libido happen in some women due to diabetes. 

Read about their causes and treatments here, thanks to our partners at DLife. 

Birth Control is extremely important for female young adults with diabetes who are sexually active, but not prepared to start a family.

Don’t get us wrong, having a safe and healthy pregnancy is very possible as a woman with diabetes, but it’s important to plan for it in advance with your doctor in order to minimize any complications. Check out this blog post from Diabetes Mine listing the pros and cons of each type of birth control to help you decide what’s right for you – and have a conversation with your doctor.

Yeast Infections are also common among women living with diabetes (lucky us.) 

Check out what causes yeast infections, how to prevent them, and how to treat them from our friends at DLife. 

Menstrual Cycles may also be affected by diabetes, and findings seem to indicate that every woman’s period affects their diabetes control differently.

For some women, their blood sugars trend high during that time of the month. For others, they trend low. And for some women, there is no difference. Continue to monitor your BGs closely during your menstrual cycle and learn more from Diabetes Health here.

Many women with PCOS also have diabetes.

PCOS stands for Polycystic Ovarian Syndrome and occurs when the egg is not released for fertilization. Many women diagnosed with PCOS also have diabetes and studies are examining the relationship between the two. Read more about the symptoms and treatment of PCOS from our friends at the American Diabetes Association.

 

Guy Stuff

Diabetes can affect the way you experience sex (yup, we’re serious.) Read on to learn about some of the most common complaints regarding sex from men living with diabetes, and how to fix them.

Erectile Dysfunction describes when a man is unable to have an erection – a common and easily treatable side effect of diabetes.

If you want to learn more about what causes erectile dysfunction and treatment, check out this blog post from our partners at Diabetes Mine. You can also read more about erectile dysfunction here, from our friends at the American Diabetes Association.

 

Celiac Disease

When you have Celiac Disease, it means that your body has an abnormal autoimmune response to gluten, or wheat. This autoimmune response damages the inside of your intestines, and doesn't allow your body to absorb nutrients like it should. Celiac Disease can be another challenge in itself when you're away at college. Check out some of these resources for information on how to best handle it.

Drugs

It’s important to know that experimenting with drugs as a young adult with diabetes is going to come with the same concerns that you should have as a person without diabetes experimenting with drugs – and then some. Whether marijuana, prescription, or any other type of drugs, abusing them can come with physical and legal consequences. As a person with diabetes, using drugs can affect your ability to accurately count carbs, take insulin, and gauge your blood sugar. Here are some tips to keep in mind from the book, “Type 1 Teens: A Guide to Managing Your Life with Diabetes” by Korey Hood.

Know what you’re taking. There are tons of ways to figure this out from asking a reliable person you’re with, to searching the internet. You could punch in a description of the pill to Google and find out what it is, what it does, and what might happen to you because of your diabetes. Do not take something if you’re unsure what it is.

Make sure you’re with someone sober who knows you have diabetes. And make sure this person knows what you took.

Try the drug in a controlled environment. Know who is around, where you are, and that your car keys are locked up.

If you’re using a prescription medication illegally, you may want to seek help from a doctor or therapist (or both) to stop. It can be really hard to stop this once you start.

Wear your medical ID bracelet. If something happens, you want the emergergency team to know you have diabetes. Emergencies can happen, and you want to be prepared when they do.

Here are some specific drugs, and what taking them means for your diabetes, courtesy of Steve Edelman from the Taking Control of Your Diabetes team.

Hallucinogens

*This includes marijuana, mushrooms, and LSD

  • Generally leads to excess calorie (and carb!) intake
  • Altered mental capacity/euphoria
  • Typically decreases physical activity
  • Could lead to hypoglycemia unawareness
  • Disorientation
  • Sleepiness
  • Loss of motivation

Uppers

*This includes cocaine, crystal meth, and ecstasy 

  • Counter regulatory hormones may raise glucose values
  • Altered mental capacity affects decision making
  • Can decrease your appetite
  • May lead to increased physical activity
  • Could lead to hypoglycemia unawareness
  • Can exacerbate CVD (vasoconstriction and increased blood pressure)

Check out Dr. Edelman’s video segment on diabetes and drug addiction.

 

Eating Disorders

  • Diabulemia is a serious eating disorder that occurs when people with diabetes purposely don’t take enough insulin in order to lose weight. If you or someone you know is suffering from Diabulemia, check out the resources below including We Are Diabetes, the Diabulemia helpline, and the National Eating Disorders Association for more information
  • Not every eating disorder can be classified. If you are worried you have an unhealthy relationship with food, contact your health care provider.

 

Depression and Anxiety

Caring for your mental health is a huge part of any chronic illness. Unfortunately, it's all too common for those with diabetes to be affected by greater anxiety and depression than the rest of the population. It is essential to remember that your mind and your body are connected - ignoring your diabetes will make you feel lousy, and ignoring depression and anxiety will make it hard to manage your diabetes. 

Do not be afraid to seek help - in fact, make it a priority. Most schools have counseling and psychological services freely available - take advantage of this. If your schools counselors are not adequate, ask for a referral from them or a friend to an area office. 

Be proactive - it's better to seek out the resources when it's not an emergency - that way when you need them, they are already there. Take care of your mental health during the good times so you can better withstand the bad. 

Above all, remember that you are not alone, and nobody expects you to handle diabetes by yourself. Reaching out to other diabetics or other close friends and you may be surprised who else is struggling with the same feelings. Get connected. That's why College Diabetes Network is here.  

Resources

Check out the following resources to for even more information and support:

Hear Our Story

 

From The Blog

CDN Chapter Leader, Sabrina, talks about diabetes and mental health in college.
Ian talks about that more than just diabetes can be going on, but there's still more to him than that.
Katelyn talks about diabetes and periods.

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