On-campus support for type 1 diabetes

1 November 2013

Being diagnosed with type 1 diabetes as a child or teenager means living with an ‘in your face’, chronic condition for the rest of your life. FIONA CASSIE talks to adolescent diabetes nurse specialist Kirsty Newton and primary health nurse Catherine Nelson about creating an on-campus, specialist support service for young people with diabetes at Victoria University of Wellington.

Leaving home for university is a big step for all teenagers — and balancing study with irregular eating, sleeping, and partying is a rite of passage for many.

But young people with type 1 diabetes can’t ‘major’ in eating poorly, sitting at the computer for hours and ignoring their health, as it will come back to bite them with a vengeance.

Even for the conscientious young person, managing type 1 diabetes is a complex and ever-present task that has to compete for attention with lectures, assignments, exams, sport and the spontaneous social life that is the norm for their peers.

It didn’t take student health services nurse

Catherine Nelson long to see that there was a gap to be filled in meeting the needs of students with type 1 diabetes at Victoria University.

When she started at Vic back in 2001, there were just two students on the health services’ books with type 1 diabetes and four with type 2 diabetes. But with New Zealand reflecting the global trend for an increase in the incidence of type 1 diabetes, the list of students with the condition grew quickly — so quickly in fact that, at one point, three students from a single university department were diagnosed within months of each other. There are now 35 students on the list.

With many of the students away from home for the first time, and a number aged only 17 or 18, Nelson saw them as a high risk group and, with the backing of health services colleagues, stepped into a new role focusing on long-term conditions and, in particular, supporting students with type 1 diabetes.

In 2006 she got to know Kirsty Newton who was working in the community as a diabetes nurse specialist for the local primary health organisation (PHO) and seeing some of Catherine’s students at Victoria.

That same year, Newton was shoulder-tapped to take on a specialist position at the Capital & Coast District Health Board as an adolescent and young adults diabetes nurse. She brought the cohort of Vic students with her to the new job.

It was the beginning of a strong and unique partnership between primary health and the DHB’s secondary diabetes services, to offer what is thought to be the only on-campus wraparound specialist service for students with type 1 diabetes.

The students have Nelson as their on-campus nurse and Newton visits at least once a month during the university year to offer joint nurse-led clinics. In between, both are just a text or email away if help is needed.

Reversing student ‘no shows’

Early on, the pair became aware of a high number of ‘no-shows’ from students failing to attend their specialist endocrinologist appointments at Wellington Hospital.

“Often the appointments were set at difficult times such as during exams or in the university holidays,” says Nelson. On other occasions, the appointments clashed with tutorials or left pressured students little time to get to and from the hospital between lectures or other commitments.

Newton says she is clear that the hospital “is not the centre of the universe” and her service’s clinical leader, endocrinologist Dr Jeremy Krebs, is luckily of a like mind. So when he was asked to offer a clinic on the university campus, he obliged.

Jeremy now comes on campus five times a year and Nelson schedules his visits to fit neatly between exams and holidays. She then faces the logistical challenge of slotting in seven or eight students between 9am and 11.45am so their appointments don’t clash with essential lectures or tutorials.

The result has been with worthwhile with the number of no-shows diving to just one in recent years. Oh yes, and one student slept in one time – but they managed to slot them in at the end of the clinic.

A week before each specialist clinic, the two nurses meet with all students who have appointments with endocrinologist to carry out blood tests and screening and discuss any issues the student has that can either be resolved by Newton or addressed when they meet with Krebs.

More than just blood tests

Leaving home to move into a student hostel or flat can result in diabetes management coming last on the list of priorities competing for the attention of a young student.

The two nurses are well aware that their young clients need more than just clinical support to manage their diabetes and also help them with the logistics of getting the practical support they need. Plus a listening ear for the usual trials and tribulations of late adolescence or young adulthood, which can be amplified by diabetes.

So they invest time in getting to know the students and their needs. Newton says the holistic care they offer can range from applying for medic alert bracelets, setting up a regular pharmacy order for insulin supplies, linking students with student services to organise exam privileges and liaising with student hostels so residential advisors know how to deal with hypoglycaemia to arranging free dental and hygienist appointments, getting funding for a private podiatry visit and helping students navigate the red tape to get a disabilities allowance from Study Link. Newton says after 12 years working on campus, she has developed a network of contacts so knows the student hall managers and how to pull the funding strings to get students the support they need.

Then, says Newton, there are the two big issues of adolescent health — sexual health and mental health. “Certainly in diabetes there is an increased risk of depression,” says Newton. “So we are always assessing people’s mental state and the kind of burden that they carry with their diabetes.”

They use specialist questionnaires to help identify people in need and can refer them to the university counselling service or for three free appointments with the DHB diabetes service’s own specialist psychologist.

Coffee groups and beer tasting

Then there are the students themselves. Two students shared their thoughts on the service at the recent primary health nurses’ college conference in Wellington. Third year student Hamish Yates says he was diagnosed with type 1 diabetes at the age of 20. He signed up with student health at the beginning of the year after a mixed experience with other health professionals who had little experience with diabetes.

He says there is a marked difference in the quality and thoroughness of the service he receives now. “I can’t stress enough how good it is to have people that really have their heart and soul in type 1 diabetes and really look after us.”

History student Kristen Davison has had type 1 diabetes for almost eight years and says moving to Wellington to study was daunting and having type 1 diabetes made it even more so. But she says the transition was made much easier by having a specialist clinic on campus — rather than a bus ride away — and being able to see an endocrinologist for the first time.

Davison also praised the effort that Nelson and Newton put into bringing students with type 1 diabetes together, including coffee meetings where she met other young people with diabetes for the first time.

And rather than a ‘dry’ lecture on alcohol, the diabetes nurses run a beer tasting evening with food which students can bring their mates to and learn about safely managing alcohol.

Nelson says alcohol is one of the first things they talk to students about, and particularly how to prevent hypoglycaemia. The beer tasting evening is a chance to demonstrate putting sensible drinking theory into practice but also a chance to sneak in advice about sick days for when a student gets a fever, doesn’t feel like eating or their ketone levels are high.

True integrated care

Having close links between Victoria’s primary care services and the hospital’s diabetes services has other spin-offs.

An example is the afternoon Catherine got a text from an unwell 18-year-old hostel student who turned out to have an infection, fever, and ketones in the blood. After being examined by the doctor and Catherine, the student was sent to the emergency department by taxi. Kirsty was away that day but Catherine’s close links with the hospital service meant she could call an inpatient diabetes nurse, by name, to forewarn her that the student was on the way. This ensured a speedy path through the emergency department to clinical assessment and a subsequent two-night stay in hospital.

Text and email is how the students and nurses keep in touch with regular emails arriving in Catherine’s Inbox from students needing a new prescription and test strips. When she gets texts about too many highs or too many lows or concerns about whether the student can trust their new meter’s readings, she refers them to Newton as the diabetes specialist.

So if you have any students with diabetes heading to Vic next year, please get in touch with the university’s student health services so the two nurses can welcome them and ease their way into student life in a new city.

Type 1 diabetes occurs when the immune system destroys the beta cells in the pancreas, stopping insulin production and leaving the body unable to use glucose for energy. It typically occurs in children and young adults. To stay alive and maintain good health, daily management involves balancing, simultaneously, injections of insulin with carbohydrate intake and exercise. While the causes of the upsurge in type 2 diabetes are fairly well-established, researchers are still trying to work out the reasons for the global increase in type 1 diabetes with number of diagnoses growing between three and five per cent a year.