Thursday, Nov. 14 was World Diabetes Day. While an estimated 415 million people live with diabetes, college students face specific challenges.
Diabetes may be one of the most misunderstood diseases, especially for college-aged students.
“People don’t really understand it as a disease,” Grace Heinerikson, a senior majoring in accounting and finance, said.
Heinerickson has lived with Type-1 diabetes for the last five years of her life. She wears a glucose monitor and a pump on her body that gives her the essential drug, insulin, throughout the day. But when Heinerikson tells others she has diabetes, she said she’s often met with doubt – something she attributes to misconceptions about her weight.
“Yeah, yeah, I am skinny. Thanks for pointing that out,” Heinerikson will often say.
“People love to say, ‘Oh, can you eat that?’ Yes, I am putting it in my mouth. I am pretty sure I can eat it. I can eat anything I want as long as it isn’t poisoned,” Heinerikson said. “I know it gets frustrating for everyone, because it’s not really showing that people are concerned about you so much. It is a juvenilization of who you are.”
This juvenilization – and the judgement surrounding her eating habits – can impact Heinerikson even more so than others, because for six months, Heinerikson was misdiagnosed with Type-2 diabetes.
During this time, Heinrikson had to starve herself and drastically change her diet. Although when it was determined that she had Type-1, she had more freedom with her diet.
“When people bring that up, it strikes a chord for me that I am not sure it strikes as strongly for everyone else, but I know it gets frustrating for everyone,” she said, referring to other people with Type-1 diabetes.
Although similar, Type-1 and Type-2 diabetes have some key differences. According to the CDC, Type-1 diabetes is a chronic disease that occurs because of an autoimmune reaction in the pancreas. For no explainable reason, the body will attack cells in the pancreas that are responsible for making insulin. Insulin is the hormone that unlocks cells, helps deliver glucose to the cells and gives the cells the energy they need to function.
Without insulin, sugar will build in a person’s blood, which, over time, if the blood sugars stay high, can poison the blood, and if poorly controlled over time can create complications for the human body.
If someone is diagnosed with Type-1 diabetes, they will be dependent on laboratory-made insulin for life. There is no cure for Type-1 diabetes. This autoimmune reaction occurs usually in children or young adults.
About 5% of diabetics in the U.S. have Type-1 diabetes. Contrary to popular belief, diet and lifestyle do not cause Type-1 diabetes. Genetics may play a role, but it is largely unknown why this reaction to the pancreas happens.
The other 90-95% of diabetics have Type-2 diabetes. Type-2 diabetes often develops in people over the age of 45 but can also occur earlier in life. Often, individuals with Type-2 diabetes will build an insulin resistance, and eventually their pancreas can’t keep up with getting glucose to cells.
Risk factors for Type-2 are being overweight, inactive, genetics or being over 45 years old. Type-2 diabetics are not always dependent on insulin, and in the prediabetes stage, diabetes can be slowed or even reversed completely if individuals make lifestyle changes.
Despite these facts and differences, diabetes, especially Type-1, is often misunderstood or stereotyped as a disease that is the individual’s fault. Heinerikson and other Type-1 diabetics have expressed how diabetes is distilled and labeled as a meme, slapped across a sugary cake recipe, say, or on a pile of multicolored candy with a hand plunging into a bowl.
Another student, Teresa Elam, a freshman majoring in chemical engineering, said she will often come across people who think she’s allergic to sugar, or that she can’t eat certain foods.
“I have a shirt that says ‘A juice box saved my life,’ which is true,” she said.
In the popular American imagination, diabetes is shorthand for “unhealthy” – a deserved sentence for eating fast food, guzzling soda, squashing down cake, accompanied with lots of sitting.
But the truth is far from that. Heinerikson brought up the image of Wilford Brimley, an actor for Liberty Medical Supplies. On screen, Brimley is an older cowboy with a mustache, and slightly overweight. In the commercials, he looks right on the camera from his horse and says with a drawl, “I have had ‘diabeetis’ for 20 years.”
Many people, Heinerikson says, think that all diabetics should have the body of someone like Brimley and are shocked when they encounter someone like her, a young woman in her 20s and who is not overweight and seemly lives an active lifestyle.
Elam, who was diagnosed with Type-1 diabetes at the age of 9, recalled having her diabetes misunderstood.
“Some [people] think, ‘You have diabetes, that’s a disease. Oh, that’s contagious!’” she said. “And the classic, ‘I made cupcakes for everyone in the class for my birthday, but oh, not for you because I know you can’t have sugar.”
Every time Elam and Heinerikson eat, they need to use insulin from the pumps on their bodies. They need to think about how much insulin is needed to help get sugar from the food they’re eating. And, if they insert insulin into their body, they have to make sure they eat something so that their blood sugar doesn’t get low.
They both expressed how important it is for them to manage their blood sugar levels throughout the day. If they have a low level, they need to pull out snacks, pay for expensive nachos at a football game and schedule their classes carefully. For Elam, a member of the Million Dollar Band, she has to make sure she takes breaks during practice to eat or manage her insulin – something that’s always on her mind.
Maintaining good blood sugar levels over time is one of the most important actions for a Type-1 diabetic. If blood sugars remain high or are poorly controlled, diabetics can face a long list of complications.
“I have it drilled into my head since age 9 that your blood sugars now are going to matter when you’re 30 whether you’re going to have or feet or not,” Elam said. “I understand that health decisions are very important. What I do now is very important.”
If blood sugars are poorly managed over the long term, diabetics can face foot amputations, a paralyzed stomach, nerve and kidney damage or eye issues.
Elam explained a turning point of realizing this importance. When she was younger, she went to see her endocrinologist after a time period of high blood sugars and not telling anyone about it.
“I was doing everything myself, and my dad was under the impression that everything was fine, everything was great,” she said.
However, after not scoring well on a test that determines how well a diabetic is managing their diabetes, she wasn’t fine. After failing to reach good blood sugar numbers, she gave up trying to keep the numbers in a healthy range.
“The doctor sat me down, asked me if I want to be healthy, live a long time,” she said. “‘Yes,’ I said. It’s OK if you have high blood sugar. It’s not a negative thing about you. There’s no such thing as being a bad or a good diabetic. As long as you’re trying your best, that’s fine.”
Once she let go of needing to always keep her blood sugars perfect, and accept that the numbers would be high on occasion, often due to things out of her control like hormones or stress, she started to do better with management.
“Once I had that switch, things got better,” she said.
Both Elam and Heinerikson are part of College Diabetes Network, an official group on campus. The group provides support for fellow Type-1 diabetics as they navigate college life. Heinerikson said the group makes fellow diabetics feel less alone.
“On Alabama’s campus in particular, we do have a large problem with students that are not involved in Greek organizations feeling alone on campus, especially as diabetics,” she said.
Heinerikson said the group is a place where Type-1 diabetics can fit, be understood, be listened to and not judged.
“If you want to sit out here and eat a pan of brownies because you are low and not an orange, I am not going to judge you,” she said. “Because I have done that, too … CDN is a place where we can support our goals and growth but not feel bogged down by the pressure. It allows us to feel in control.”