Nathan Reilly has had Type 1 diabetes since he was a baby. And until last week, the 19-year-old always had his mother to help remind him of the litany of tasks people with diabetes must do.

Check blood sugar. Adjust insulin pump. Watch what you eat. Be careful how much you run around.

Now a freshman at Pennsylvania State University, Reilly feels confident he can manage on his own — he spent much of his senior year of high school practicing the routine. But of course he still worries.

A few times in high school, Reilly fell asleep with low blood sugar and experienced a seizure. Now living in a dorm, if his blood sugar is low when he tests before bed, Reilly plans to stay awake until it comes up.

Managing a chronic health condition, such as diabetes, can be difficult regardless of your age. But a new study suggests that it may be especially challenging for college students, who are adjusting to all the changes of campus life plus managing a disease on their own for the first time.

Diabetes distress is high among college students, and can negatively affect their quality of life, said a study by researchers at Ohio University and published in the Journal of the American Osteopathic Association. Researchers also found elevated diabetes distress among faculty and staff.

“This is a population we need to focus on in terms of addressing their health outcomes,” said Elizabeth A. Beverly, an assistant professor of medicine at Ohio University and the study’s lead author. “If you’re not controlling your diabetes, for even four years, that can have a major impact in terms of complications down the road.”

People with Type 1 diabetes, an autoimmune condition in which the body does not produce insulin, must diligently track their blood sugar levels and their carb intake, and administer insulin. People with Type 2 diabetes, where insulin production is compromised, may also need to adhere to nutrition guidelines and take medication.

Frustration with these self-care requirements, concern about the future and the possibility of developing complications, and perceived lack of support from family and friends can contribute to diabetes distress. Many survey respondents showed signs of severe depression.

Reilly wants to make sure the new friends and classmates he meets don’t misunderstand what it means to have diabetes. Sure, he can’t eat whatever he wants whenever he wants, but he is still in control of his life.

“It is kind of a pain to deal with, but a lot of people that I come across are like, ‘Oh, you can’t do this, you can’t do that.’ And that’s not the case,” Reilly said. “I can do pretty much everything someone without diabetes can do; I just have to be careful.”