This document summarizes a presentation about supporting young adults with diabetes in college. It discusses the unique needs of this population, resources available to providers and students, and the College Diabetes Network model which provides tools, campus communities, and support networks. Case studies are presented to illustrate challenges commonly faced by young adults with diabetes. The presentation aims to help providers better understand and assist this group.

1. Supporting the young
adult with diabetes:
Understanding
the unique needs of this population
and resources available to both
students and providers.

2. PRESENTERS
• Christina Roth
• CEO and Founder, College Diabetes Network
• Danielle Petrunich
• CDN Student Leader at Bentley College
• Dr. Jake Kushner, MD.
• Chief, Pediatric Diabetes and Endocrinology, McNair Medical Institute
Scholar, Baylor College of Medicine, Texas Children's Hospital
• President, Society for Pediatric Research
• College Diabetes Network Board Member; Board Liaison to CDN Clinical
Advisory Committee

3. PURPOSE & LEARNING OBJECTIVES
Purpose: The purpose of this presentation is to provide insights into the unique
needs of the young adult with diabetes, from both clinical and student
perspectives, and to arm providers with resources available to better support
this vulnerable population.
Learning Objectives:
1. Describe the unique needs associated with young adults living with diabetes
on campus.
2. Explain considerations when interacting with young adults with diabetes in a
clinical setting.
3. Identify resources available to both providers working with young adults with
diabetes on campus, and to students themselves.
4. Describe effective ways in which to interact with and support young adults
with diabetes.

4. THE CDN MODEL
Tools Network Ecosystem
Resources and
information on how to
navigate diabetes in
college
Campus communities
that connect you with
other young adults
with diabetes
Making your
environment and
supporters better
prepared to support
you
Clinicians
Parents
Campus
Faculty
Campus
Health YOUN
Friends
G
ADULT

5. A DAY IN THE LIFE

29. TAKEAWAYS
• Diabetes is hard and a full-time job, and we are trying our best at it
• We struggle every day to find the right balance between attention to our diabetes
and living a “normal” college life
• Individualized care
• We don’t need scolding or lecturing from you- that’s what our parents
are for!
• The best thing you can do for us is give us empathy and support
• Peer mentoring—having a friend to talk to is huge!

30. THE CDN MODEL
Tools Network Ecosystem
Resources and
information on how to
navigate diabetes in
college
Campus communities
that connect you with
other young adults
with diabetes
Making your
environment and
supporters better
prepared to support
you
Clinicians
Parents
Campus
Faculty
Campus
Health YOUN
Friends
G
ADULT

31. RED FLAGS: DIABETES IN THE CLINICAL ENVIRONMENT
SCENARIO: DIABETIC KETOACIDOSIS
A 19 year old student is brought in by friends on a Sunday morning with a “stomach
bug”.
Was with his pledge class on a “road trip” and must have eaten “some bad food”.
Diabetes since age 7. Otherwise in good health.
Usual insulin regimen is a combination of long-acting (30 units of insulin glargine a.k.a.
Lantus) and short acting insulin (10 units of insulin aspart a.k.a. Humalog).
Checks blood sugars before breakfast, lunch, dinner, and at bed. In “good control”.
Pulse is 170, with a respiratory rate of 55 breaths/minute and blood pressure of 150/60.
He looks thin, a bit somnolent, and smells of vomit and alcohol.
Physical exam: notable for deep, forceful breaths and a small bruised lump on his left
abdomen.
Blood sugar is “high” and his urine reads “large” ketones.
Transferred via ambulance to the local emergency room.
Initial blood chemistries: Venus blood gas: ph 7.03. Blood glucose: 851. HbA1: 12%.

32. YOUNG ADULTS WITH DIABETES: AVERAGE
HBA1C SIGNIFICANTLY HIGHER THAN ADA
GUIDELINES & INCREASING (T1D EXCHANGE
DATA, 2014)
8.2%
8.3%
8.7%
8.4%
7.7%
7.6%
8.3%
8.4%
9.0%
8.7%
7.7%
7.6%
9.0%
8.5%
8.0%
7.5%
7.0%
<6 6-<13 13-<18 18-<26 26-<50 ≥50
Mean HbA1c (%)
Age (years)
Enrollment Current

33. 3-month Frequency of Severe
Hypoglycemia*
According to Age
5% 6%
* Seizure or LOC: 1 or more events in 3m
8% 8%
11% 12% 13%
50%
40%
30%
20%
10%
0%
<6 6-<13 13-<18 18-<26 26-<50 50-<65 ≥65
Age (years)
Copyright of Unitio

34. Goal: Best possible outcomes in type 1 diabetes
patients with highest quality and safety of care
“People with diabetes should receive medical care from a
team that may include physicians, nurse practitioners,
physician’s assistants, nurses, dietitians, pharmacists, and
mental health professionals with expertise and a special
interest in diabetes.”
“The management plan should be formulated as a
collaborative therapeutic alliance among the patient and
family, the physician, and other members of the health care
team.”
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Pediatrics
leveraging patient-centered collaboration

35. Goal: Peer-to-peer support of type 1
diabetes patients

36. RED FLAGS: DIABETES IN THE CLINICAL ENVIRONMENT
SCENARIO: DISORDERED EATING
A 22 year old student is seen for an acute respiratory illness.
She is wearing multiple layers of clothing.
Diabetes since age 10 Otherwise in good health.
Usual insulin regimen is short acting insulin via a pump.
Checks blood sugars before breakfast, lunch, dinner, and at bed. In “good control”.
Pulse is 52, with a respiratory rate of 20breaths/minute and blood pressure of 90/50.
Physical exam: extremely thin with a BMI of 15 kg/m2.
Blood sugar is “312” and his urine “moderate” ketones.
At your urging she submits to lab testing.
HbA1: 14%.

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Pediatrics
Goal: Inter-disciplinary research to optimize
psychological and health outcomes in type 1 diabetes
Barbara Anderson, PhD
Marisa Hilliard, PhD

38. RED FLAGS: DIABETES IN THE CLINICAL ENVIRONMENT
SCENARIO: “BRITTLE DIABETES”
“NON-COMPLIANT”“NON-ADHERENT”, “LAZY”, “BAD”
A 18 year old student is seen for routine vaccination.
He has had diabetes since age 2. Otherwise in good health.
Usual insulin regimen is short acting insulin via a pump.
Checks blood sugars 6-8 times a day. Reports his diabetes is in OK control but he has
lots of highs and lows.
Physical exam: unremarkable except for multiple bruises near pump insertion site on
abdomen.
Blood glucose and insulin administration history via the insulin pump reveals large
swings in blood glucose values (from 50 to 500) with large carbohydrate content in
meals (up to 150 grams per meal).
HbA1c is 9.5%

39. Goal: Inter-disciplinary care and research to optimize
health outcomes in young adults with type 1 diabetes
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Pediatrics
Kelley Cerasuolo, NP
Sarah Lyons, MD

40. RED FLAGS: DIABETES IN THE CLINICAL ENVIRONMENT
SCENARIO: “DIABETIC PREGNANCY”
A 25 year old graduate student is seen for a pregnancy test.
Last menstrual period was “about 2 or 3 months ago”
She has had diabetes since age 12. Otherwise in good health.
Usual insulin regimen is short acting insulin via a pump.
Checks blood sugars 2-10 times a day. Reports her diabetes is in “OK” control.
Physical exam: unremarkable.
HbA1c is 10%

41. Peri-conception HbA1c strongly influences risk of
congenital anomalies in infants of diabetic mothers
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Bell et al, Diabetologia 2012

42. Goal: Prevent unplanned pregnancies in mothers with
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type 1 diabetes

43. Goal: Prevent unplanned pregnancies in mothers with
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type 1 diabetes
Jaden Schupp

44. RESOURCES FOR PROVIDERS OF YOUNG
ADULT PATIENTS
1. Online resources
1.CDN Website
1. New section for Campus Providers and Administrators
2. Hub of resources and information for college students with diabetes
(upcoming local events, scholarships, new expert FAQs, etc)
2.The Endocrine Society Directory of Endocrinologists
2. College Diabetes Network’s Interest Database
I. Semester Clinical Update (Being launched in August 2014!)
II. Visit CDN’s Booth (#503) in the Exhibit Hall to sign up, or email
Christina (croth@collegediabetesnetwork.org)

45. CHAPTERS
Support networks on campus created
and run by students
Chapters provide:
 A safety net of people to call
 A way to meet other students juggling school and diabetes
 A place to share tips and get acquainted with local resources
 A chance to take a leadership role
 An opportunity for community outreach
 Access to the latest diabetes technology
 Invitations to events on campus

46. CHAPTER RESOURCES
We provide chapters with:
 Chapter Webpage
 Chapter Email Address
 Personal support from CDN’s
Program Director
 Student Advisory Committee
(SAC)
 Materials
o Chapter Toolkit – instructions
on how to create and run a
sustainable chapter
o Includes templates,
instructions, documents,
brochures, flyers, forms

47. Stay in Touch!
Christina Roth
croth@collegediabetesnetwork.org
Dr. Jake Kushner
kushner@bcm.edu
Dani Petrunich
dpetrunich@gmail.com
W W W. C O L L E G E D I A B E T E S N E T W O R K . O R G