6 Must-knows for the College Sick Day with T1D


Editor’s Note: For more information on managing type 1 diabetes in college, sign up for Beyond Type 1: College Edition, our email series on all things college + type 1 diabetes (T1D).

Ask any parent of a young child with T1D what they dread the most as they look forward to their child’s future, and you will likely hear the same response: the day I send my T1D child to college. Make no bones about it, sending a child with a chronic illness off to college for the first time is scary. It was my greatest fear when my son was still in elementary school, and it continued to be my greatest fear as I crossed the days off the calendar leading up to his departure to college as a freshman.

Our fears are normal. The beginning of college marks the end of our 24/7 vigilant care for our child and the end of our illusion of control. The potential risks of nocturnal hypos, blood sugar swings from alcohol consumption and DKA due to illness had us locked in fear for our child’s wellbeing.

But we don’t have to remain locked in fear. I’ve found the best remedy for fear is action. Here is my advice on the six must-knows for your T1D college kiddo’s sick day.

Prepare for unexpected hypos

  • Get a continuous glucose monitor (CGM) if your child doesn’t already have one. A CGM is an essential tool, especially at detecting those nocturnal hypos when parents are no longer at hand for nighttime blood checks.
  • Glucose tabs and 4 oz. juice boxes can be ordered on-line and delivered right to your student’s campus box. Make sure your child knows how to order these items.
  • And by all means, talk with your child about the effects of alcohol on blood sugar (Learn more).

And now, let’s get active preparing for illness.

Get Medical Power of Attorney on file at your child’s college and local hospital

Some schools may tell you they don’t need one, but the local hospital will require a MPOA if your child is ever admitted to the ER and you wish to speak to the medical team.

Learn more about filing for medical power of attorney, here.

Have your child get a flu shot

Sometimes schools hold a flu clinic to administer the shots, and when they do, they usually notify parents by email the dates and times so it’s easy to remind your child. If your child doesn’t get a flu shot at school, make sure he gets one when he is home at Fall break or Thanksgiving.

Read The Truth About Flu Shots.

Always test for ketones when you’re sick

This is one of the most important things your child needs to know. We are all taught to check for ketones when blood glucose is higher than 13.3 mmol/L240 mg/dL, but did you know that ketones can also be present with normal or low blood sugars? Infections or other illnesses can cause the body to produce higher levels of certain hormones, such as adrenaline and cortisol, both of which counter the effect of insulin, putting the body at increased risk for ketoacidosis.

Be vigilant in teaching your child that whenever he has an illness, ketone testing is a must, regardless of blood sugar level!! Be sure your college student knows to drink 10-12 ounces of sugar free liquid per hour to help clear ketones, and be sure his ketone strips are IN DATE!!

Read What Saved My Son’s Life.

Always keep your glucagon handy

The thing with emergencies is that they are unexpected and unpredictable. This is where taking action ahead of time to be prepared is of utmost importance. Always have 2 IN DATE glucagon kits filled. Keep one in plain sight—like on a desk or dresser, and one in the student’s backpack/bag that she carries with her.

Editor’s Note: While older Glucagon Emergency Kits (GEKs) could be a bit daunting to use, there are now several easy-to-use glucagon options, including a nasal spray, auto-injector and prefilled syringes. 

It is so important to have quick access to glucagon in an emergency. If your student is spending the day off campus—in the mountains, at the beach, skiing, anywhere that is more than 30 minutes away from home or a hospital—be sure she takes her glucagon. Vomiting, from food poisoning or a virus, can come on very quickly, and if vomiting begins shortly after a meal that is accompanied by a large dose of insulin, blood sugars can plummet so quickly that glucagon may be needed.

While our children are hopefully familiar with using ketone strips, they are most likely not practiced with using a glucagon. Before sending your child off to college, have her practice mixing and drawing up an expired glucagon; she may need to administer it herself one day or explain how to use it to a friend.    

If you’re vomiting…

Nobody likes to think about vomiting, much less talk about it. But a few pointers may be helpful. Be sure to include a few small bottles of Coke and Diet Coke in your student’s emergency supplies for college. Remind them, or teach them for the first time, how to alternate SIPS of one or the other depending on blood sugar levels. Remind them not to chug the soda, but to sip it. The goal is to avoid dehydration, without drinking so much as to induce more vomiting.

Pumpers (those using insulin pumps) are also taught to reduce their basal insulin to elevate their blood sugar enough to give themselves a correction dose of insulin. When done effectively, this practice can help prevent DKA. If interested, ask your medical team for guidelines on how to do this before your student leaves for college.

And most of all, tell your child not to be shy about calling 911 if she is vomiting and has ketones. Before my son left for college I drilled in a simple rule: If you throw up, you go to the hospital. I was so glad he listened, because when he had a stomach virus his freshman year and was vomiting throughout the night, he didn’t hesitate to call 911 at the point when he discovered he had “large” ketones.

Communication is key

Managing diabetes is difficult enough on the best of days. When sick, it can take more mental energy than our child can muster up. Encourage your child to communicate with you at the first sign of illness so you can be another set of “eyes” from afar. Also encourage your child to ask someone who has easy access to him (a roommate, a hall mate, etc.) to check in on him every couple of hours. And be sure you have the names and phone numbers of your child’s friends!

It is true that a little preparedness goes a long way. So take enough action to be assured your child is prepared for the adventure that lies ahead of him, and then rest in the confidence that you have taught him to stand securely on his own two feet.

Read more resources on going to college/university and Bonnie O’Neil’s The Stomach Flu Away from Home.

WRITTEN BY Bonnie O'Neil, POSTED 08/14/18, UPDATED 10/29/22

Bonnie O’Neil is a mother and sister to three family members with type 1 diabetes (T1D). Her new book, Chronic Hope: Raising a Child with Chronic Illness with Grace, Courage and Love weaves a story of hope amidst the challenges of raising a child with T1D. More of Bonnie’s writing about finding hope and joy in the hard seasons of life can be found at www.bonnieoneil.com, on Instagram @bonjourbonnieo and Facebook: Bonnie Woods O’Neil.