(originally published in Avenue magazine, June 2005)

By Ceri Frid

“Have a good weekend”, the doctor said nonchalantly as he handed David a sample of insulin and needles. That was the afternoon his blood sugar level dipped for the first time. Just two weeks before, 18-year-old David Yoder had been told he was a diabetic. On October 12, 2001, a doctor checked his blood sugar level at 500 milligrams per deciliter, which was 400mg/dL above average. This particular Friday afternoon, it fell to 98mg/dL as David grappled with the notion of giving himself shots all weekend without aid from the nurses he’d seen every day since his discovery.

“I was freaked out. I went from having no problem at all to having type one diabetes. That changes everything.” It was David’s freshman year in college. A three hour drive from home, and without a car, he could hardly turn to mom for help on this one, but he was determined to get through it. For the first few weeks, he bummed rides from friends and neighbors so he could receive daily shots from the doctor’s office. Bounced around because of insurance issues, the last doctor told David he had to learn to do it himself. By the following February, finger pricks and insulin shots were replaced by an insulin pump. Since then, David has been permanently hooked up to a little black box that keeps his insulin level stable through a needle in his lower side. Every few days must to reposition the needle, but it eliminates the trouble of a shot every day.

It’s been over two years since David learned about his diabetes, but he says he could never forget the day he found out. It was an October day, falling prey to winter, and in jeans, tennis shoes, and a fleece jacket, he trudged from his 9.30 a.m. anthropology class to the health center on campus.

“In September, I went home for the weekend with strep throat. I was drinking a lot, and constantly using the bathroom, but I put it down to the diuretic medication I had been prescribed,” he says. A month later he returned to the doctor on Mom’s orders. He had lost five pounds in five days, and was drinking two liters of water and a grande cup of coffee in one sitting. With diabetic grandparents on both sides of the family, he knew what to expect. But as he sat on the cold, rigid bed in the doctor’s office, hearing the frightening truth, he didn’t know what to think. While David called his Dad from the waiting room, the campus doctor arranged an appointment that afternoon where he would receive his first insulin treatment. It’s ok, his father reassured him, you’ll get through it.

Back at his apartment, he broke down for the first time. Sitting with a neighbor, he recounted the day, and thought about his new disease, and everything it implied.

Diabetes Mellitus type one is the least common form of diabetes. People diagnosed with diabetes mellitus are insulin dependent and usually of a young age group. According to the American Diabetes Association, only 5 to 10 percent of diabetics in America are type one. Diabetes is an autoimmune disease that transpires when the insulin producing ‘beta-cells’ in the pancreas are destroyed and cease production of the hormone insulin. The body needs insulin to absorb glucose from blood cells and transform it into energy. When this does not occur, glucose levels in the bloodstream continue to increase, which causes a high blood sugar level. If diabetes goes untreated, severe health problems will arise. High sugar in the blood for extended periods of time is responsible for causing multiple long-term defects such as heart disease, blindness, high blood pressure, nerve damage, and kidney failure.

Diabetes type one is a serious disease that requires consistent monitoring and treatment. It is not something that can skip a day’s dosage, or be ignored until later. It is a disease that cannot be temporarily disregarded for a weekend road trip, or a 21^st birthday party. Missing medication because of a night of boozing won’t leave a diabetic with just a hangover in bed, but possibly with a coma. David is a junior in college, and a brother in a fraternity. He is one of many college students who barely have time for five hours of sleep, a half decent meal, and phone calls to parents. How, in a world filled with parties, all night studying, 8 a.m. classes, deadlines, Taco Bell at one in the morning can David, and other diabetic students, find time to manage this deadly disease? In so many ways, they are like other college kids, but do not have the luxury of spontaneity and laziness. In living a college life, they must learn to juggle fun and irresponsibility with insulin injections and blood sugar levels.

It is a reactionary relationship between a college student with diabetes and the disease. The disease affects their lifestyle, but their lifestyle affects the disease. There can be no one or the other in this situation, diabetics must be able to compromise in order to stay in control. “Ignoring it will only kill you,” says Dr. Timothy Ballard, a professor of anatomy at the University of North Carolina Wilmington. “This is a life-long and life-threatening problem.” Among his advice for diabetic college students, Dr. Ballard suggests drinking should be highly restricted.

“I do drink a lot,” says Kenne Mountford, a student at the Medical University of South Carolina. Kenne graduated from UNCW in May 2003 and for the past year has been pursuing a graduate degree in computer science in Charleston, S.C. He says he doesn’t drink as much as when he was an undergraduate but has always been cautious when consuming alcohol. “When I am drinking, I try to test my blood sugar often. I always test it when I come home for the night to make sure my blood sugar level is OK before going to sleep,” Kenne says. He admits there have been instances where his blood sugar has become extremely low while drinking, “but thankfully,” he says,” “a friend or I have been able to fix the problem by getting me sugar.”

Kenne was diagnosed with type one diabetes mellitus when he was 22 months old. “Like most other babies I was crying nonstop. I was extremely thirsty and my parents were continuously giving me Coke, which is actually really bad for diabetics,” Kenne explains. “Eventually they rushed me to the hospital where I was diagnosed.” Now, at age 23, Kenne has had the disease for over 21 years. Growing up with the disease, he has learned to control it, but has lead a life different from those who constantly surround him. “When I was younger, the negative effects diabetes on my life was not being able to eat those great sweets, like cookies and cake, which all my friends ate. Now that I am older it causes me to be more cautious because I am afraid of the long-term complications associated with diabetes,” Kenne says.

Although Kenne admits to a lot of drinking, he insists he is careful about it, and responsible, when it comes to other aspects of his life. Like exercise, “I try to surf if I have time and if not I play tennis once a week” says Kenne. He knows he has to keep his body healthy. Christy Eakins, a pediatric P.A. in Wilmington, N.C., says “any increase in weight may cause problems with maintaining blood glucose in a normal range, therefore, regular exercise and a relatively strict diet is necessary.” One of the greatest difficulties Kenne had when growing up was balancing insulin intake with his diet. Four years ago, however, Kenne got an insulin pump to help with treatment. “It has allowed me to have a more flexible diet.” he says. Now he does not have to worry as much about restricting himself from certain foods, but he says he still tries to limit the amount of saturated fats he consumes.

Unlike Kenne, David has not grown up with diabetes. He didn’t suffer during his childhood, and he got an insulin pump just months after diagnosis. But that has not made coping with diabetes any easier. After 18 years of living as he pleased, David had to change daily routines. From what he eats for breakfast to where his future takes him, David’s life has changed drastically since his freshman year. He came to college with the intention of going into education. “But now,” he says, “I want to work with children who have diabetes.” As a psychology major David hopes to use his college experiences to help children who have difficulties coping with the disease. “The hardest thing is that nobody understands it at all,” he says. He wants to be able to lend some understanding to young people that need it. David’s desire to reach out to kids doesn’t lessen his own troubles with diabetes.

“It really changes your outlook on life,” David says, talking about the recent ban on stem cell research. “It seemed so close,” he says, “we could almost taste a cure.” There is a sense that maybe even David’s political views have been affected by his disease. In addition, the last two and a half years haven’t just taught him how to give himself insulin, or to watch his diet, but also the value of his own life. “Freshman year I missed so many things because I was sitting at home,” he says with a furrowed brow, “I don’t want to hold myself back.”

David is still an active member of his fraternity and doesn’t like to miss out on mixers and functions. He says that he is never pressured by his brothers to drink. “I do drink every now and then,” he says, “but I never really liked to drink anyway.” He mentions, “One time I was drinking a lot and my blood sugar crashed like a stone in water.” He knows that when it comes to his health, the buzz isn’t worth the danger. David says he is worse at maintaining a regular diet, exercise and sleep program than he is at avoiding alcohol.

“I get about four to five hours (of sleep) a night” he admits. Mrs. Eakins, says, “Disturbed or insufficient sleep may cause problems because it will lower the body’s immune defenses.” Sleep is important to most college students because of the high stress they come under during mid semester exam periods and the end of the semester rush. “Stress will put the body at risk for hyperglycemia,” says Eakins. Hyperglycemia is an excess of glucose in the bloodstream.

David knows he should get more sleep, but it’s just not that easy for him. With a heavy school workload, living in a house full of fraternity brothers and working 25 hours a week at a restaurant, David’s time is spread thin. “I’m so stressed out between school, fraternity and work,” he says. “One time I couldn’t get my blood sugar below 200mg/dL, but then two weeks ago I had to go to the ER because I couldn’t get my blood sugar up.” Amazement still forms on his face recalling the events, and, sipping a frozen coffee, adds, “It’s something you never really get used to no matter how hard you try.”

This is the attitude that Megan Lewis has, adopted as well. Twenty one years old, Megan has been diabetic for 13 years and she lives in Wilmington with her husband, a diabetic as well. She graduated from UNCW in December 2003 and is currently making the transition from college life to the real world. She speaks of the disease as “something that [she is] constantly adjusting to.” When Megan was eight, she rapidly dropped 16 pounds and gulped down water to such an extent that her parents took her to a physician. She was diagnosed with Type-One diabetes and spent the next seven years restricting her diet in much the same ways Kenne had to.

At fifteen she got an insulin pump and since then has been able to maintain a fairly free diet. Megan attempted not to let diabetes get in her way during college but says “sometimes I didn’t feel as good as I would have liked to.” She ran everyday to stay fit and avoided alcohol. “I have a glass of wine or a beer every once in a while but I don’t drink enough to have to worry about it,” she says. She checks her blood sugar level at least eight to ten times a day but she notices when her levels are off. “I always feel really weak when I’m low and dizzy when I’m high.”

Megan’s greatest obstacle with diabetes in college was the ability to study through the night. “I could definitely tell a difference in my blood sugar if I only slept for three or less hours and all nighters really affected how I felt,” she says. Megan was always responsible with her disease while in college. Her senior year roommate, Lauren Zuccarelli, recalls “she showed me where she kept her emergency insulin kit in case I ever needed to help her.” Lauren never had to come to Megan’s aid although Megan was exact in her cautiousness.

“You have to alert your friends and room-mates of symptoms of hypo and hyperglycemia,” says Eakins. Megan’s responsibility in college is due in part to her reflections on the disease. She explains, “When I was young I would wonder why I had it, but over the years I have realized that having it has given me a certain awareness about my body and a compassion for others that would be different otherwise.”

Awareness is key for David, Kenne and Megan. In every aspect of their lives they have to be more alert. And it is not just the medications, the hospital visits and the needles they have to try to get used to, it is coming to terms with a disease that will never go away. “You resent it,” says David, “you have to think about it everyday.” A close friend of David’s, Cameron Koontz, who has known him since they were in eighth grade, has watched him grow with the disease. A freshman at UNCW with David, Cameron was one of the first people to find out about David’s diabetes. She says, “when he was first diagnosed with diabetes it was very easy to see the differences; he was very irritable and very depressed about having to deal with it. But now he’s accustomed to the permanent changes he’s had to make in his life.” As for Kenne, he may be used to being diabetic, but he still says, “The disease is scary, yet mysterious.”

All have found support in their friends and family though, “my life has been saved by most of my family members and close friends at least once in my life,” Kenne says. It is so important to remember, as Eakins says, that you should “know how to manage your own illness before leaving home,” and have a supportive network of family and friends to fall back on. Megan and her husband are able to learn and gain from each other. Megan says, “Although I wish that neither one of us had to deal with it, I think that we definitely support each other in dealing with the disease.”

Everyone’s battle with diabetes is not the same. Kenne, Megan and David have all had their own experiences with diabetes in college and in the rest of their lives. It is a disease that fluctuates with every person because each body is unique. Coping mentally with the disease is also something that a person reaches alone. Megan captures the thoughts of all three when she says “it is something that I have learned to live with, but also something that I hope to one day live without.”