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Diabetes Services at Campus Health
October 16, 2014

Campus Health offers a variety of services and resources for students with diabetes. We sat down with two resident experts, Dr. Margaret Vimmerstedt and Rachel Selinger, Pharmacist and Certified Diabetes Educator to learn more.

What unique struggles do students with diabetes face on campus?

Dr. Vimmerstedt: With Type 1, there is a risk of low blood sugars. There is lots of walking involved on a college campus - especially at UNC with lots of hills and long distances from one side to the other. Exercise tends to make the blood sugar go down, so we remind students about some of the behaviors they need to employ for their immediate safety like always carrying some kind of sugary snack and making adjustments in insulin for a college lifestyle.

Rachel: Another struggle is a whole new group of people that students have to tell about their diabetes for safety reasons.  Students have to deal with telling people because folks will see them check their blood sugar or self-administer insulin before they eat, etc. In situations with alcohol, students with diabetes can be at risk for a serious low blood sugar even hours after they have had their last alcoholic beverage, so their friends and roommates should know about their diabetes to be able to recognize this.

Plus, students are often transitioning from lots of parental involvement to becoming their own primary caregiver – especially as they come directly from high school to college. They have to learn the healthcare system, how to transfer and fill prescriptions, and how to access Dr. Vimmerstedt if they need care.

What opportunities and services exist to support students with diabetes at UNC?

Dr. Vimmerstedt: Campus Health is available to you – your appointments with the diabetes team are free due to the Campus Health fee paid in tuition and fees. Rachel is a Certified Diabetes Educator and Annie Penrose is an experienced nutritionist. So we have people that you can see for education and nutrition, plus you can see me for physician visits. Students also have opportunities to get their insulin and supplies at the pharmacy.

Rachel: That’s right – any students or post-docs can obtain diabetes supplies at the Campus Health Pharmacy. And with the student health insurance plan, your copay is only $10 per month’s supply for each prescription, which is often significantly lower than copays available at outside pharmacies.

Dr. Vimmerstedt: Another thing – students can get their labs drawn here. It’s always important to know how our lab works with your insurance, but we are in-network with all student and post-doc insurance plans, all Blue Cross and Blue Shield plans, and later this semester we will be in network with Cigna. Plus, it’s convenient to get labs done here because it’s on campus and there’s usually a very short wait. We are happy to co-manage patients with their endocrinologists and send lab results to providers outside of CHS.

Rachel: There are so many services with CHS that are useful for all students – including those with diabetes. For example, Counseling and Psychological Services is an excellent service to know about as far as managing stress - a big health issue for everyone.

We also have the Heels and Hearts student group, which is a diabetes advocacy and outreach group. We partner with two national organizations: Students with Diabetes and the College Diabetes Network. These offer a variety of online resources and ways to connect with students with diabetes across the country. Historically, the group has participated in JDRF fundraisers and the local American Diabetes Association (ADA) walk. This year we’re also looking at the “Tour de Cure,” an ADA bike ride in the triangle. The Heels and Hearts group has hosted some community workshops for parents and teens with diabetes and offered the support of trained student members who are available to talk to other students as peer mentors. Several members have volunteered in the community at summer diabetes  camps or in hospitals.  We also do some education during our meetings to meet the needs of the members – it’s a great environment to learn from the experiences of others with diabetes at UNC.

How could I learn more about diabetes services and support?

Rachel: The main hub for information is the diabetes care page on the CHS website. Everything we offer is centered there. You can also find the Heels and Hearts group on Facebook – we have a closed UNC only group as well as a page where people can see information or post things that they don’t mind being more public. I recently wrote an article on the Healthy Heels blog about the support systems at UNC, in the local community, and online, so students can use that as a reference. There are also websites for Students with Diabetes and the College Diabetes Network, and we are working on updating our group’s info on those pages.

Switching gears a bit, what inspired you to focus on students with diabetes?

Dr. Vimmerstedt: For me it brings together so many aspects of health – exercise, nutrition and more. Early on when I started at UNC, I was asked to continue to offer a diabetes support group which had started before I arrived. I worked with Janice Ryan who was a great mentor and helped me learn ways to be supportive. So for me it has always been a clinical interest. I’ve also grown to love the diabetes camp where I now serve as Medical Director, which has helped keep my interest level high.

Rachel: For me, a large part of my residency training and role as an independent pharmacy practitioner has involved the care and support of patients with type 2 diabetes. In that role, I saw people who were really sick and had been for a long time. In my current position at Campus Health, I more frequently see people with diabetes who are young and healthy, and I have the opportunity to help them prevent some of the complications that I saw in the older, sicker populations I’ve worked with previously. College students with diabetes are amazing: they manage a lot of things every day that students without diabetes may never even consider. Managing diabetes can be time consuming, challenging, and frustrating; I like to be able to support these students as much as I can to help them stay healthy and happy and successfully reach their academic and personal goals while at UNC!

Dr. Vimmerstedt: Both of us really enjoy doing preventative medicine. In this population, prevention can make a huge difference.

Your answer brings up another question for me. What IS diabetes and what is the difference between the types?

Rachel: In general, diabetes is having excessive sugar in the bloodstream. But how that happens with each type is different.

With type 2, insulin doesn’t work as well at allowing sugar to go into the body’s cells. This is called insulin resistance. Type 2 has underlying insulin resistance plus sometimes inadequate insulin release from the pancreas. With type 2, sometimes insulin is necessary, but often lifestyle changes and oral medications are enough to control it. 

With type I, the production of insulin is completely gone because of an autoimmune process that has attacked the pancreas, which is the organ that produces insulin in the body. The pancreas is not releasing insulin, which is the hormone that allows sugar into the cells, and sugar is trapped in the bloodstream. Without accessible sugar, the cells are starving and they use fat for energy. For someone with type I, insulin is a lifeline. Without it, the person would die.

Both types require daily attention. It helps to have a lifestyle that is very physically active and to know the amount of carbohydrates in your food. But with type I, because you’re taking over the work of what your pancreas is doing, it requires frequent and precise calculations of insulin and carbohydrates.

You two obviously work collaboratively. How does pharmacy and primary care connect on this?

Rachel: Every health care provider is taught a different way of educating patients. It’s best to have as many people educating in as many ways as possible to best connect with the student.

I find it helpful to be a pharmacist because I can see the product dispensed (insulins, test strips, etc) and help with insurance issues. A big part of diabetes management is making sure you have the supplies you need to care for yourself. I also have training in the mechanism of action of different medications, and which therapies may be best suited for particular patients, lifestyles, and medical circumstances.

Dr. Vimmerstedt: We want to be patient-centered. We’re interested in helping people develop health goals, focus on those and achieve them.

Come and see for yourself!

Dr. Vimmerstedt works in the Primary Care clinic of CHS on the main floor. Rachel works on the ground floor in the Pharmacy. You can also meet with Annie Penrose, nutritionist, on the second floor of Campus Health.All three are available by making an appointment using the Healthy Heels portal or by calling 919-966-2281.