Balancing T1D and College Basketball: An Interview with Cassandra Falone of St. Michael’s College

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Cassandra is a graduating senior at St Michael’s College in Vermont. She was diagnosed with type 1 diabetes in sixth grade. During college, she played on the school basketball team and was also President of the St. Mike’s chapter of the College Diabetes Network. She spoke about her experience balancing diabetes and college basketball with the JDRF Northern New England staff.

 

Can you start by talking about when you were diagnosed with Type 1 Diabetes (T1D)?

I was diagnosed with T1D in sixth grade, I think I was 12. It was during the winter, right after Christmas, and I was in the middle of basketball season and I was going to the bathroom four times a night. My grandparents were visiting, we were making cookies, and my blood sugar was probably super, super high. My parents took me to the doctor, who was about 20 minutes away.  I remember having to stop twice to pee on the way.

The doctor sent me to the emergency room, and I was in the hospital for three days after that.  After all the blood tests, I was diagnosed with Type 1 and Celiac. But after a week or so, I went back to playing basketball.  One of my really good friends actually had diabetes when I was diagnosed. She was in my friend group, so that was kind of cool. She brought me to the nurse’s office every meal, and kind of taught me the ropes of everything.

 

Let’s fast forward to diabetes in college. What technology do you use to manage your diabetes?

I have the Dexcom. During junior year, I had the Freestyle Libre for a couple months, it was good but I didn’t love it, and then I got the Dexcom and I really like it. But I don’t have a pump.  During freshman year in high school, I had the Omnipod for about a month, but I was playing a lot of basketball and it kept getting knocked off so I stopped using it. I am still just using the Dexcom right now, and the InPen for shots, so it’s some technology.

 

Can you talk about your experience in general of having diabetes in college?

In high school I didn’t really tell anyone that I was diabetic, only my friends knew. Once I got to college, though, I went to pick up a sharps container from the campus health center and the nurse told me about this new club someone was forming called the College Diabetes Network.  It’s a national organization but they were starting a chapter at our school.

There was one junior guy who was forming it and it was just him and a bunch of his friends. A friend and I decided to join and that was the first step of meeting other people who are diabetic, and that was really cool. And then, moving forward from that, I became President my junior and senior years and all my friends were in it just for fun.  During that time, someone else I knew of at school got diagnosed and she joined with a couple of her friends.

There was a hockey player at school with diabetes. You would kind of just get to know the people who are diabetic through having diabetes. St. Mike’s is a small school, about 1500 students, so it was a great community.  I knew most of the diabetics on campus, which is really good, not only to connect with them, but it was also helpful if you ever needed something. One time the girl who played hockey asked, “Do you have extra ketone strips? I ran out.” And it was really nice to have connections like that.

I think going to college I was scared to tell people. Growing up in a small town, I never had to tell people about my diabetes. All my friends were the same friends I’d had since fourth grade, so everyone just kind of knew. Once I got to college, it was weird having to tell people for the first time. The basketball team knew because I had to step out and do things like giving shots.

By the second half of freshman year, I had a close friend group.  I didn’t tell them, I just started doing things in front of them and they figured it out. During the last week of school my senior year one of them saw me taking an insulin shot and they said, “What are you doing?”

The have all been super supportive, though, and even joined our chapter of the College Diabetes Network with me. And I think telling people at school makes your relationships a lot closer with them, kind of being vulnerable with them.

It’s not always easy being different but I feel like the more open you are with it the easier it is to deal with it.  I don’t think it ended up being as big of a deal as I thought it was going to be.

 

What was your freshman year living situation like?

I had a roommate who was on the basketball team. I told her before I got to school that I’m diabetic just because I wanted to make sure she wasn’t afraid of needles or anything. But she was very supportive. She was also premed so she kind of had to know about it.

I think most of the people I encounter don’t know much about diabetes but are still super supportive. I’ve never encountered anyone who was like, oh that’s bad, or weird, or anything negative.

 

As a senior looking back on your college experience, was there any really challenging things particularly relating to your diabetes?

Yeah, the dining hall for me was terrible. Just the measuring of food and carb counting in the dining hall is very difficult. I had my own kitchen my junior and senior year and that was a lot better. But going from senior year in high school where I would know exactly what’s in the food that either my parents or I was cooking, then going to the dining hall having no idea at all was tough.

I think at first it was a big adjustment, but then after a while I could kind of gauge what serving was which. But, I feel like they add so much stuff to dining hall food too, that I didn’t really know what was in it.

They never had the carbohydrate information, only the calories. So it would be like mashed potatoes, this many calories and I’d be like, I have no idea how many carbs that is. That was definitely very challenging for me.

I always made sure to let my professors know before class started that I was a diabetic.  I wanted to make sure they knew why my phone was freaking out with my Dexcom beeping.

 

Did you have any official accommodations?

I didn’t get anything official from the school. When I needed something I asked my professors for it, and they were usually understanding.  One of my professors was also diabetic, and when I went to tell him he said, “Oh yeah, me too.”  We ended up talking for awhile, and that was kind of cool.

 

How did you end up at St. Mike’s?

I’m from New Jersey and I played AAU basketball. Our team traveled around a lot and I met some recruiters and I ended up getting a scholarship to play at St. Mikes.

I think a lot of it, too, was the community at St. Mike’s that made me really want to go there. I knew, with diabetes, that I had to be closer to the coach and have an understanding relationship. And, Division 2 is nice because you’re not allowed to train in the summer, unlike Division 1 where you stay all year around .

We would get training packets for the summer and I could dp them at home, which I liked a lot. When picking a school, I had to consider that I’m going to need to give my body a break, and I’m going to need to go home if I need to. At the end of Freshman year, going home was really important because I’d had so much trouble managing the food at the dining hall that my blood sugar was not great.  I needed the time to rest and regulate my body.

 

When choosing a college, was the distance a concern for you or your parents because of the diabetes?

I would say no. My brother went to college in Florida, so I think they were used to their kids being kind of far, and St. Mike’s is drivable. But I think by the time I got to high school, they weren’t really that involved in my diabetes, or my diabetes control. So, I think that helped a lot, they were able to let go more easily.

And I think it helped too that there wasn’t CGMs and Share. Because I think if I had a CGM back then, and they were connected to it, then it would be different. But there was not really a way for them to check up on all my numbers while I was at school.

 

How do you think it would be different for you if they had the Dexcom share?

I think if in high school they had Share, my parents wouldn’t have let go as easily. If my blood sugar was high, I dealt with it and figured it out on my own. But I feel like if my parents knew it was high then they would step in and try and help me. Then I wouldn’t have learned as fast how to control it on my own.

The girl at St. Mike’s who plays hockey is T1D, and her parents still have her Share on, which is really helpful if she’s going out, or even has a really low blood sugar at night. I actually know of two of the kids at college have the Share on still. And their parents will call their friends to wake them up, which is really helpful, because that’s scary. But I think my parents never having it, they didn’t really know what they were missing.

 

Let’s talk about the role of T1D in college sports. How do you manage your diabetes during a basketball game?

My Dexcom would tell my trainer on the sideline what my blood sugar was. My trainer was great. She would trust me with all my decisions. I would tell her at the beginning of the year that 80 is the number if I’m low. But, if I was above 250, I would say we need to figure that out before I go back in the game.

Generally, games make my blood sugar go straight up. And it was pretty bad freshman year because I was so nervous. I didn’t start like I did in high school. So I sat on the bench and all the adrenaline building up would send my blood sugar up, and then when I would go into the game it was be 250 or higher. I had to kind of figure it out as I went along but I think the Dexcom helped a lot.

When I was in the game, I would leave my phone with another player on the bench who was injured.  If the phone beeped, they would give it to my trainer and I would get taken out.  Once I got the hang of it all, it didn’t really happen often.  I would have a lot more lows in practice than in games.

The Dexcom was very helpful to me, but could be very scary for other people who aren’t familiar with T1D because the beeps are really loud. I’m used to having low blood sugar so I’d hear the beeps and think, okay, yeah, it’s going low, I’ll be fine. But my coach and my trainer would be worried and say, “Oh my God, are you okay?” It was very scary for them.

But I think sitting out in practices would be the hardest thing for me because, especially in college practices, everything we do has a purpose.  If I sit out for five minutes, I’m going to miss something important. If I’m sitting out for 30 minutes, or a whole practice even, that’s going to be a big chunk of stuff that I’m missing which could affect playing time for the next game. It was frustrating because it was out of my control.

When I was a freshman and sophomore, I would purposely keep my blood sugar high, over 200, just so I wouldn’t get taken out.  By junior and senior years, I realized that I wanted to play better at a good level.  And I also understood the importance of having good blood sugar and I would just deal with the lows because they are going to happen.

 

Do you ever notice if maybe your shot’s a little off or you’re missing free throws, do you attribute that to a high or low blood sugar?

I didn’t really notice that in my shooting, but I did notice it had an affect on my focus. I get spacey when my blood sugar is high, and I would be slower, not even on the ball, just like a little bit behind. Someone might back cut me or I’d be looking up into space.

On the other hand, I would get very frustrated with high blood sugar. I think that’s something my coach noticed too because she’s like, “Are you okay?” Or if I’m just really low too. She’s like, “Are you okay?” Because I would just get emotional and frustrated at things that I normally wouldn’t get frustrated at.

 

Does having diabetes present any other challenges during basketball?

I think the mental aspect of having diabetes and playing sports is huge, especially having to sit out for some workouts because of blood sugar issues.

My biggest fear, especially going in freshman year, was thinking that people would think I was taking the easy way out, or using diabetes as an excuse to get out of practice, which was absolutely not the case.

I was very impressed with my teammates, though, and they would go out of their way to make me feel good and they would understand when I was going through a rough patch. I think teammates being reassuring and supportive and knowing what’s happening is huge, and my team is really good at that.

My coaches are the same way. They don’t know what high blood sugar or low blood sugar is necessarily, or how diabetes works fully, but they are very supportive, and understanding. Like if I said, I don’t know if I can play, or I don’t know if I can do this workout because of something going wrong with my blood sugar.  And they’re like, “Okay, totally understand.”

Or okay, maybe you should just sit this out, it’s not that important. So I guess the blood sugar control they don’t have as much to do with, but the mental health support, just being there for you, and understanding and trusting when you say you’re not okay.

And there’s a lot of times where I would say I’m fine because I wanted to play, and she’d be like, “No, you’re not, you’ve been on my team for a while, you’re not.”

 

How often is your blood sugar a reason for being taken out of a game?

It’s only been a couple of times, but there was one time I couldn’t play. My blood sugar was like 350 – 400 and I couldn’t really figure out why. My coach said, “Just don’t play, it’s not worth it.” That was this year and it was upsetting because I didn’t know what was causing it at the time. It turned out I had the flu and it was causing my blood sugar to go up before I got any other symptoms, but I didn’t know that at the time.

It was so frustrating because obviously we worked for however many days of practice, to play in the game. After all the hard work, the games are the fun part.  And it was senior year and I didn’t want to miss a game. So just not being able to play because of that was annoying and frustrating.

 

How did your playing time change over your college career and did you have to adapt your blood sugar management to that playing time?

I’d say freshmen and sophomore year, I played almost every game. But, it was a little harder because I wasn’t playing enough where my blood sugar would go down. It would probably play 10 out of 40 minutes.  One quarter of basketball isn’t enough to bring down my blood sugar. But the adrenaline was still really exciting going into the game. There were a lot of games I would just take insulin before and not eat anything because I knew my blood sugar was just going to go straight up. And I think that was a lot harder, especially the fear because if I went low I couldn’t play, and then if I went too high I wouldn’t play well.

So that balance was tough. But the Dexcom this year really helped a lot. And then junior and senior year, I got more playing time. So I think this year I definitely got a better hang of it, mostly because I wasn’t as afraid of going low because the Dexcom would tell me if I was headed that direction. It was much easier to stay within 100 to 200, because I wasn’t as fearful of tanking, because I knew where my blood sugar was all the time.

But, I think freshman year my adrenaline was crazy because I never played college basketball and the competition was higher. And junior, senior year, it wasn’t as big of a deal because I had been doing it for so long that I was more used to it.

 

Did you ever have trouble keeping the Dexcom on during games?

Actually, one game it came off. It’s funny because we tried so many different things to get it to stay on. But my trainer and I would work together, we would put that black adhesive tape over it that you use for physical therapy stuff. All of the supplies in her office we tried. The problem with the tape is that it would work for the game but when I would take it off, it would rip off the entire Dexcom.

What ended up working is I would just wear a long sleeve compression shirt, and that was the best.

 

When you first started playing with a CGM, did it take a while for you to get used to it? Were you very conscious of it playing at first?

I don’t think it was hard to get used to.  I only was conscious of it when we tried to tape around my entire arm, because I could feel it if I moved my arm. But I don’t really notice it at all.

 

Even if it’s on your shooting arm, it doesn’t really make a difference?

Not really, but there is a funny story. For a couple of games, I was having trouble with my insurance and getting the Dexcom was very complicated. So I didn’t wear it for a couple of games this year, and I missed all my shots so my coach was making the joke, “You need the thing on your arm, that’s why.” But, I got it back and I started making shots again, so maybe it helps.

 

On a separate note, what’s your favorite part about Vermont?

The people. It sounds weird but I’ve never met nicer people in my entire life. And I don’t know if it’s just St. Mike’s or Vermont in general, but the professors and the staff who work at my school are just the nicest people and they really care. I have good relationships with so many people at that school, which is really important to me, and I feel like it’s a small community.

I also think that in Vermont, there’s a lot more care around things in general, about being good people and effecting change in the world, beyond sports. I think the commitment to helping others and making your student athletes be good people, is something I find very important and I really liked about St. Mike’s. And Vermont is just beautiful.

 

Being a graduating senior, do you have any final reflections about your college experience with diabetes?

I think in college, it’s a totally different diabetes experience. I think there’s so much more to focus on that you didn’t have in high school. Sometimes diabetes isn’t at the forefront of your mind and you don’t take care of your diabetes as well. At least that was my experience freshman year. My A1C went up a lot because I didn’t keep it as a priority. But I also think going into college it’s okay to make some mistakes with diabetes, but at the same time that you have to remember you’re diabetic and it’s important to take care of your blood sugar.  When I’m home, I have my parents to remind me.  At college, it is just me.  A college schedule isn’t as routine as high school… maybe you don’t eat breakfast because you woke up late or, whatever it is. But I think you have to totally relearn how to have diabetes at college.