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hen Richmond native Rachel Beckner was preparing to go off to college last fall, she decided to stop wearing her insulin pump because she didn't like the way it looked.
Insulin pumps, usually worn on the hip, help diabetics manage the disease with short-acting, adjustable doses of insulin 24 hours a day. With a pump, diabetics can be more flexible about what and when they eat, rather than planning meals around the effects of insulin shots.
For Beckner, 19, shedding the pump meant taking more responsibility for regulating her blood sugar levels. Instead of programming her needs into her pump, she'd have to inject herself with insulin multiple times a day.
"It was rough at first," Beckner said.
Making the switch got easier as time went on, though, and she liked not wearing the equipment.
"But my blood sugar [levels] weren't as good as they should've been," Beckner said.
So, after a pump-less year at the University of Alabama in Tuscaloosa, Beckner has decided to start wearing it again. She's choosing the convenience of using it over the aesthetic appeal of going without. Her parents, she said, encouraged the decision.
Their priority was disease management, not style, and Beckner said she agrees the pump makes it easier for her to stay on top of her diabetes.
"I actually like the pump better, even though aesthetically I don't," Beckner said.
Beckner, who has had diabetes since she was 7, is one of thousands of young people who head off to college each year with a chronic medical condition.
For these students, managing their health puts added pressure on dealing with the everyday ups and downs of college life.
On their ownBefore leaving for college, most teenagers have the support of their parents to help with their disease management.
Whether it's a reminder to check their blood sugar or a hand in scheduling appointments and picking up prescriptions, parents often play a vital role in keeping their teens healthy. They can serve balanced meals, and nudge their kids to go to bed at a decent hour.
When a student leaves for school, parents' ability to do all that diminishes.
Medical professionals say that's why it's important for students with health conditions to be well prepared to take care of themselves.
For a diabetic, this means having a strong handle on monitoring blood sugar levels, said Aaron Kowalski, director of strategic research projects for the Juvenile Diabetes Research Foundation.
For a student suffering depression, it may mean maintaining a schedule of therapy appointments. For an asthmatic, it can mean studiously avoiding smokers. For students with a variety of conditions, it can mean being sure to get enough sleep.
Meeting with their health care provider before leaving home is a good way for students to prepare for the challenges they might face.
Barbara Wagar, director of the psychological services center at the University of Mary Washington, said clinicians can help students plan for how to cope if problems arise.
"Generally, going off to college is something that most students will look forward to," Wagar said. "But whether they have a psychological disorder or not, it's a big change for them, so it's going to be stressful. How they will cope with it will depend a lot on how they have prepared for it."
Beckner said she gave up the pump several months before leaving home and knew how to monitor her blood sugar levels. Even so, she noticed there's a difference between managing her diabetes at home and doing it on her own at school.
"My parents aren't there to monitor what I eat, or ask me if I've checked my blood sugar and done my shot, and I really have to be responsible about that," Beckner said. "It was harder in the beginning."
Lack of consistencyOne of the biggest challenges students with chronic conditions encounter is the lack of a consistent daily schedule.
Clubs, jobs, late-night studying and courses on alternating days make it nearly impossible to maintain a daily routine.
Wagar said trying to incorporate as much routine as possible into the day can help.
"I think having some structure to your day is a good idea for anyone," Wagar said. "It helps you manage your time better, it helps you make sure that you're not missing meals or not getting enough sleep, and it also allows you to make sure that you do have time to relax and socialize."
Along with routine, resisting the temptation of alcohol or drugs is important for students with medical conditions.
Beckner said she goes out plenty with friends but doesn't get as wild as some other students because she knows drinking can affect her diabetes.
Nathan Fountain, associate professor and director of the comprehensive epilepsy program at the University of Virginia, said drinking also can have adverse effects for epileptics.
Having a drink is not the problem, he said, but the circumstances surrounding college drinking can lead to seizures.
"Staying up late and partying tend to precipitate seizures," Fountain said.
Even eating can pose a challenge for some students. Those with food allergies, diabetes or other conditions may need to eat, or avoid, specific foods. Yet students may have a hard time finding nutritional information for the food served in cafeterias or other popular college eateries.
To help her cope with that problem, Beckner said she uses a book that lists the carbohydrate and sugar contents of many foods.
Whom to tell?Students with medical problems often face another quandary: the choice of whom to tell about their condition.
Just who needs to know depends in part on the disease.
For a student with epilepsy, Fountain said the student has to decide which people around them might witness a seizure.
"If a seizure is even somewhat likely to occur, it's important to tell anyone that they are likely to see on a regular basis," he said.
This can be helpful to the student because it means they won't be taken to the hospital every time they have a seizure.
For a student with diabetes, it's often wise to let roommates know so they are able to recognize the signs of dangerously low blood sugar, said Kowalski, of the Juvenile Diabetes Research Foundation.
Beckner, who roomed with a high school acquaintance, said she showed her roommate how to give her a shot in case of an emergency.
She said she's also been open about discussing her diabetes and insulin injections with new friends.
"For people who have just met me, I try and explain to them what I'm doing so that they don't freak out at the dinner table," Beckner said.
A challenging opportunityStress, which strikes most students from time to time, can have an especially negative impact on existing conditions--whether by triggering seizures, causing a drop in blood sugar or increasing feelings of depression or anxiety.
Beckner said she carries a snack when she is feeling stressed out because the stress often causes her blood sugar levels to go down.
Many schools offer free counseling sessions for students feeling depressed or anxious. Students at UMW can attend up to 10 sessions a year at the psychological services center.
Wagar said the center encourages students to come in, even if they just feel a little overwhelmed.
"If something is big enough to bother you, it's big enough to talk about," Wagar said.
Students can also seek help from providers off-campus. Offices such as Wagar's, for instance, have information about local providers and can help students make appointments.
Medical conditions shouldn't set students apart from their peers, and they shouldn't carry a negative stigma, medical professionals say.
Despite the extra challenge of living with a chronic condition, Kowalski said college is a time for students to excel.
"It's a real challenge and it's going to be hard," Kowalski said. "But it's an opportunity to really become an adult with your education as well as your health."
Beckner, now entering her sophomore year, agreed.
"You get a lot of responsibility out of it," she said. "I learned that I could take care of myself on my own, and I could deal with my diabetes and not have to rely on [my parents] for everything."
Staff writer Janet Marshall contributed to this report.
