How to Manage College Sick Days With Type 1 Diabetes

Almost every college student catches a cold, the flu or a stomach bug at some point. Getting sick can throw your blood sugar way off. Add exams, classes and assignments on top of that, and it’s easy to feel too overwhelmed to ask for help. 

But with a plan in place, you can get through sick days at college while managing type 1 diabetes (T1D). This guide covers some tips to help you prepare and manage sick days with T1D at college.

How to be proactive about your health before a sick day hits

There are many ways to get ahead of or even prevent rough sick days with T1D. First, let’s talk about how you can keep your health in a good state with T1D at college.

Prioritize your mental health

Your mental health matters too. Whether you’re sick or “feeling fine,” anxiety and depression are common in college. Add T1D to the mix, and it’s even more important to reach out when you need help. Your family and friends want to help when you’re struggling, physically or mentally. You are not a burden. Let them help you.

If you’re managing (suspected or confirmed) anxiety or depression along with T1D at college, take these steps:

• Talk to your healthcare team: when checking your devices or managing your diabetes starts to feel like too much.
• Reach out to your college’s mental health counselors: this is usually free and already included in your tuition.
• Find community: The Diabetes Link, a group for teens and young adults with diabetes, may have a chapter on your campus.
• Call or text 988 (the Suicide and Crisis Lifeline): if you need help and don’t know where else to turn. It’s free, confidential and open 24/7. You can also chat live on the website.

You carry more stress than the average student because of T1D. Support is out there—use it.

Monitor your physical health

Stress, social pressure, late nights, indulging in buffet-style college meal plans, or skipping meals because of an irregular schedule or mismanaged time can affect your health just as much as a cold or the flu, especially when you’re managing a chronic illness like T1D. Cold and flu symptoms can also feel a lot like a low or a high, so it helps to know what’s actually going on.

If you’re feeling off, take a minute to reflect on your day. Ask yourself:

• What did I eat? 
• How much did I sleep? 
• Did I move my body today?
• How am I feeling overall?

Anxiety can sometimes feel like a blood sugar swing, so checking your blood sugar first can help you figure out what’s really going on before you assume the worst.

T1D shouldn’t stop you from having the social life you want in college. Just know and respect your limits—everyone has them, even your friends without diabetes! It’s human. By knowing and respecting your limits, you’ll teach those around you to do the same. Things like drinking or pulling an all-nighter can affect your blood sugar more than you’d expect, so a little extra caution goes a long way.

Wear medical ID: physical or digital

You’re in a new place, surrounded by people who don’t know your history. Medical ID jewelry tells first responders you have T1D, which can make a real difference in an emergency. If you don’t wear jewelry, your phone can do the same job. 

Both iPhone and Android let you set up an emergency medical ID that shows on your lock screen without unlocking the phone, and it costs nothing to set up. Either way, make sure it lists an emergency contact and that the emergency contact is up to date.

Having physical and digital medical ID forms is best for overall proactivity and safety at college.

Build habits that help you stay well with T1D

College life often means late nights, whether you’re studying or out with friends. 

That can make T1D harder to manage, but there’s a lot you can do to stay ahead of it:

• Eat something with protein or fiber before you head out for the night, so your blood sugar has more to work with.
• Move your body. Even a walk between classes counts! Find an exercise you enjoy, as it can help you stay accountable for getting enough activity day to day.
• Learn how alcohol and carb-heavy nights out actually hit your blood sugar, so you can plan for it instead of guessing in the moment.
• Protect your sleep when you can. It affects your blood sugar more than most people realize.

It’s worth saying out loud: skipping drinks, heading home earlier or stepping away to check your blood sugar can feel isolating when your friends aren’t doing the same. That feeling is real. Finding people who get it, whether that’s a roommate, a partner or a chapter of The Diabetes Link, makes a real difference. 

If you choose to go alcohol-free, that doesn’t mean sitting out, either. Many people find they genuinely enjoy being the mocktail person at the party. You don’t need a drink in your hand to have a good time.

Get a flu shot to lower your risk of diabetes-related flu complications. COVID vaccine guidance has changed for people with T1D since 2019. Today, it depends on your personal health and circumstances, so talk to your healthcare provider (HCP) to decide what makes sense for you.

What to do if a sick day hits with T1D at college

Unfortunately, even if you’re great at managing your health, things still happen. That’s life! You’re exposed to new viruses. And while your immune system is building, part of that means taking a hit, too. If you find yourself navigating a sick day with T1D at college even if you’ve been proactive, don’t be too bummed or hard on yourself. Stressing out about it will only make it worse. Instead, here are some tips to take care of yourself.

1. Watch your blood sugar and ketones closely

If you use a continuous glucose monitor (CGM), watch the trend arrows so you can catch highs and lows early. Blood sugar can swing fast when you’re sick, since your body releases extra stress hormones. Check for ketones any time you’re sick, even if your blood sugar isn’t very high. Ketones can still happen even with “normal” blood sugar levels—ketones can build up without a high blood sugar reading to warn you. This matters especially if you use an insulin pump or take certain medications.

Consider sharing your data with someone on a sick day, especially overnight. Apps like Dexcom Follow and LibreLinkUp let a friend, roommate or family member see your blood sugar in real time, so someone else has eyes on you when you’re not feeling well enough to keep track yourself. Diabetes management apps that pull your CGM, pump and log data into one place, like Gluroo, can also make it easier to spot patterns when you’re too sick to think straight.

Don’t do more manual labor than you need to while you’re recovering.

If you use an automated insulin delivery (AID) system, familiarize yourself with your pump’s manual mode before you need it. Most manufacturers recommend switching out of automated mode if you have ketones or suspect diabetic ketoacidosis (DKA), since the algorithm isn’t built to manage that. Ask your care team when and how to make that switch, so you’re not figuring it out for the first time while you’re sick.

2. Keep emergency glucagon on hand

If you’re vomiting, it can be hard to treat low blood sugar by eating or drinking. A ready-to-use glucagon, either a nasal spray or an auto-injector pen, can be lifesaving in that moment. Keep one within reach and make sure a roommate or close friend knows where it is and how to use it.

3. Don’t wait to go to the emergency room

If you can’t stop vomiting or your ketones are high, get to the emergency room (ER). Don’t wait to see if it gets better on its own. If you can’t drive yourself, call your campus police or public safety office. They can help get you an ambulance. Save their number in your phone before it becomes an emergency.

4. Let your professors know early that you’re unwell

Being sick might mean retaking a test, asking for an extension or missing class. Most professors will work with you if you communicate early and clearly. An excused absence for illness is a normal, reasonable thing to ask for.

5. Stay in touch with your healthcare team while you’re sick

Keep an open line with your care team. Ask them how sick days should change your carb ratios, correction doses or how often you test. Make sure your prescriptions are current, and keep extra supplies on hand before you actually need them.

6. Have a plan if you commute

If you’re sick, don’t commute to campus. Your health comes first. Let your professors know you can’t make it in. If you live off campus alone, reach out to family or friends for backup. And like students living in the dorms, keep sick-day supplies stocked at home.

7. Use your school’s accommodations

Colleges are required to provide accommodations for students with T1D under Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. Unlike in high school, this isn’t automatic. You’ll need to register with your school’s disability services office and request an accommodation letter. That letter can cover things like extra time on exams, permission to eat or drink in class and excused absences for medical appointments.

T1D is personal: use this guide to get started, then individualize it!

These tips can’t cover everything, but they’re a solid starting point. The Diabetes Link, your school’s health services and your campus’s public safety office are all there to help you build a plan and get through sick days with less stress.

Diabetes is a personal disease, so while general guidelines are helpful, what you might be managing on top of your diabetes should also be accounted for. A lot of things in life with T1D can be pointed back to it, but not everything. If you believe something you’re experiencing goes deeper than that, seek help. 

T1D is a lot, and even if this is your first time away from home or you’re struggling to make new friends, remember you’re never alone. Your family is always a phone or video call away and online communities are waiting to support you who’ve been through it before or are navigating the same thing as you right now!

Go beyond your diagnosis! Use our guides to thrive with diabetes, whether you’re new to it or just need a refresher. College is a big change, and you deserve a strong foundation. That means optimizing your diabetes management.