Generally seeing a person in a wheelchair, wearing a hearing aid or carrying a white cane tells us a person may be disabled, but some disabilities are invisible and can limit daily activities without any noticeable symptoms making life difficult for many people.

Professionals know how to accommodate hearing, vision and mobility impairments on campus, but chronic pain conditions, autoimmune diseases and other less visible illnesses and impairments, present different challenges. Students at the University of Rhode Island have diagnosed illnesses, which can be unknown to those around them.

Diabetes can qualify as a hidden illness, which is a metabolic disease where the body is not able to produce any or enough insulin and causes elevated levels of glucose in the blood. This disease affects 8.3 percent of Americans according to a report released in early 2011 by the Centers for Disease Control and Prevention (CDC).

Alicia is one of a population of college students here at URI who lives with type-one diabetes.  Parts of her day are spent arranging her meals and snacks to make sure that her blood sugar levels do rise too high or drop too low.

“The best way obviously to control your blood sugar is to really have a pretty strict schedule of eating, which kind-of means a pretty strict schedule of other things,” Alicia said. “[But in college] there’s just so many things happening that sometimes you don’t get a chance to really structure your own schedule.”

Coming to college and living on campus with an invisible and – largely unpredictable – illness has made life problematic for Alicia who has to accommodate her illness while trying to enjoy the new freedoms of college life. One mistake can leave her in diabetic or hypoglycemic shock and can result in an emergency room visit. Alicia recalled a Saturday night, after less than two drinks, waking up in the middle of the night with her blood sugar level registering at 34 miligrams per deciliter – 70 miligrams per deciliter is considered low for your blood sugar.

“My blood glucose level was able to get so low on that night during my freshman year of college because my body did not alert me, which it usually does,” she said.

Unfortunately for diabetics, college is not the best place to control such a disease.  One of the most important aspects of regulating diabetes is to avoid excess and maintain discipline.  When it comes to the  “college lifestyle,” whether it is the easy availability of large quantities of food, the accessibility of alcohol or just the overall the spontaneity of college, controlling an illness can make for difficult situations.

“I’m not looking for sympathy and I’m the first to admit that there are other far worse diseases out there, managing diabetes is not easy,” Alicia said. “It requires focus and resolve and leaves little margin for error.”

Students who feel overwhelmed or need the help of a counselor have access to the university’s Counselling Center, which offers free services. The center has been understaffed, according to its director, Dr. Robert M. Samuels. The center would need to increase their staff size and invest in expensive securities measures such as a secure email for the clinicians, among other changes, before the center would meet standards outlined by organizations like the International Association of Counseling Services, Inc., IACS.

Sabrina, a pseudonym for a student who asked to remain anonymous out of privacy concerns, did not have the best experience at the center during the past fall semester. When Sabrina realized her family was moving to another country, her depression started to act up and because of a knee surgery she was not able to cope like she normally would by exercising.

During her intake meeting she described how she was led to believe she could continue to met with her intake counselor or meet with a graduate student. After meeting with the grad student and realizing this new arrangement would not work for her, she tried to meet with her original counselor but was not able to because she was completely booked.

“It was confusing as to why they would give me the option, but not really give me the option [to see the initial counselor],” she said.

Sabrina recognized that if she had been more proactive earlier in the semester that she would have been able to meet with the counselor she felt was most effective for her. Ultimately Sabrina decided she did not need to continue seeing a counselor and cancelled her appointments.

“Even though I did not have the best experience, I know that what they do there in itself is really good,” Sabrina said. “They have group sessions and that kind of stuff, if I had gotten there earlier in the semester I would have been able to go do something like that.”

Samuels noticed the center sees an increase in stress and anxiety on campus in the weeks after the mid-term exams each semester, most likely because students know what is required of them to either improve or maintain their grades.

The counseling center offers individual treatment and group sessions that cover how to flesh out your identity to academic induced anxiety. The center offers couples therapy and has outreach programs for any group or organization that is looking for presentations on different topics.

“We have a fairly diverse staff in terms of skill sets and we have gone to classrooms and have gone to some of the Greek organizations who are looking for a particular type of presentations,” Samuels said.

Samuels described how they wanted to increase the physiological services available to URI students, particularly with the arming of campus police. He expressed how he wants to see the center become a 24-hour clinic on campus or even contract a third-party to cover on-call and after-hours. Currently, if someone has an emergency after hours that is over the capacity of housing staff on campus to handle, the only option students have is to go to the emergency room.

“Sometimes that’s perfectly appropriate, but I think that there are a number of people that would like an intermediary step,” Samuels said. “During the day, we are the intermediary step.”