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When my daughter was close to entering the school system, I had a lot of fears as to how the school was going to manage her sugar levels.
Since she was diagnosed with Type 1 Diabetes at 15 months old, I started thinking about this transition when she was ready to enter Preschool, between ages 4 and 5.
If you are in the same boat of thinking:
What am was I supposed to do now? My child is in xx grade…
Keep reading so you learn what are the accommodations that you need for your diabetic child.
Do you need an IEP or a 504 plan?
As a parent of a child with a medical condition, such as diabetes, you need to set in place everything in your power to keep your child safe, but that he/she is successful at the same time in school.
For a child with Type 1 Diabetes, you need a 504 Plan for these school accommodations to take place.
An IEP (Individualized Educational Plan), is written for kids who have a severe mental health condition, low IQ, behavioral issues, or struggles severely with their academics.
Diabetes is considered to be a disability due to the child/adolescent needing insulin 24/7, and they require to be under adult supervision in order to prevent severe impairment or death. Most of the kids fall into this category.
What is a 504 Plan?
Here is what I found from the American Diabetes Association (ADA) website:
The term “504 Plan” refers to a plan developed to meet the requirements of a federal law that prohibits discrimination against people with disabilities, Section 504 of the Rehabilitation Act of 1973 (commonly referred to as “Section 504”).
A 504 Plan sets out the actions the school will take to make sure the student with diabetes is medically safe, has the same access to education as other children, and is treated fairly. It is a tool that can be used to make sure that students, parents/guardians, and school staff understand their responsibilities and to minimize misunderstandings.
The purpose of the 504 Plan is to ensure your child’s academic success and access to the learning environment. Since blood sugar levels do affect their learning and concentration, a 504 Plan is a must.
On the ADA website, I found some templates of 504 plans that you can use for the development of your child’s school plan.
Also note, that these are guidelines. You should always refer to your child’s school district and see how they do their own 504 plans, but if they have no idea how to do one, these are good starting places.
There is also the Children with Diabetes website, where parents submit their own redacted 504 plans, and they are categorized by grades, age, and if the child is on multiple injections or on a pump. They are free to download, with no email input.
How Does a 504 Plan Meeting Work?
In order for you to have a 504 Plan for your child, you will need to schedule a meeting with the school counselor, school nurse, and as many of your child’s teachers who can attend.
At this meeting, you should discuss:
- the medical condition that your child has
- this is the time to bring up any other struggles your child may have (other than Diabetes)
- bring any supporting documents such as medical documents from your child’s Endocrinologist with you to the meeting.
As the meeting progresses, the counselor or another school personnel will help you outline the accommodations that may help your child succeed.
Considerations To Have On Your Child’s 504 Plan
If the Diabetes management that you want is not written on the 504 Plan, the school will be unable to act, since they are not legally protected. So make sure to revise the 504 Plan as many times as necessary during the year, and make sure that everything listed there is updated.
The 504 plan is designed to allow your child to still be as independent as possible, but to receive the help/accommodations they need when they need it.
Make sure you have the following on your child’s 504 Plan:
1. Train school staff to treat your child’s Diabetes
You with the school will identify the personnel that will be managing the Diabetes. This person needs to:
- know how to test blood sugar levels and interpret the results
- know how to measure and administer insulin, (either by syringe or insulin pump)
- know how to respond to hypoglycemia (low sugar) events, this includes the use of the Glucagon kit.
2. Location and time for testing
The school needs to provide an appropriate location for daily blood sugar testing (i.e. it can be in the nurse’s office or in the same classroom).
These tests can be in the morning at snack time, pre-lunch, before recess, after recess, etc.
Of your child uses a Continuous Glucose Monitor (CGM), like Dexcom G6, this will not be needed, unless there is an extreme high (400+ mg/dL or extreme low (below 55mg/dL). You can write on the 504 Plan to test them.
3. Access to restrooms and water
Your child needs to be allowed unrestricted access to the restroom, water bottle and/or water fountain, snacks, and the nurse’s office when he/she is not feeling well. Your child can carry a bottle of water and extra snacks.
4. Insulin delivery
A nurse or a designated person will supervise daily glucose monitoring and administer insulin via injection or insulin pump.
If there is a substitute school personnel, who is not aware of how to administer insulin and read glucose readings, the school needs to call the parents to inform, so they can take the next action they feel most comfortable with.
5. Blood sugar testing
Having extreme highs and lows can have an effect on your child’s testing, therefore the following needs to be added to the 504 plan: blood sugar should be tested before important tests. Your child needs to eat his/her snacks regularly on their scheduled snack times even if he/she is during a test. If your child needs to manage their diabetes (correct their glucose and/or eat something) and it takes them 20 mins to do it, these 20 mins needs to be added at the end of the test as an extension.
6. Recognizing low blood sugars
All school staff in charge of your child should have been trained on how to recognize these symptoms.
A designated person will accompany your child on any trips away from school when you as a parent is unable to attend.
8. Parental notifications
Parents need to be notified when food/snacks supplies need to be replenished when your child has abnormal readings, there are insulin pump problems when there is a significant schedule changed when the nurse is absent, and if the school is going on lockdown. School personnel needs to notify you as soon as possible.
9. Substitute Teacher/Substitute Nurse
They need to be notified of your child’s diabetes. For the teacher, he/she needs to know who is the person in charge of managing your child’s diabetes. If on a test, the substitute teacher should be notified in the lesson plan of the testing schedule before the test.
10. Lunch Time
Your child can go to the front of the lunch line to get their lunch and/or milk so that he/she has time to get his/her food started before insulin is administered.
11. Going to the Nurse’s Office
Please inform to the teacher, school nurse, and other school personnel, to now allow your child to walk down the hallway with an extreme high and/or low blood sugars. Your child should ALWAYS be accompanied by an adult or a responsible student when going to the office/nurse’s office if he/she is not feeling well.
12. Emergency supplies
Your child needs to have emergency supplies and insulin pump bag (or meter/syringes/insulin), and these need to be listed on the student roster. This is to ensure that it accompanies your child during fire drills, field trips, and any time he/she leaves the school grounds.
13. Lockdown situations
Your child will have his/her blood sugar meter and snacks in an additional location that is accessible during school lockdowns.
Your child should use his/her blood ketone meter (or urine ketone strips) anytime that her blood sugar is over 300 mg/dL.
15. Physical Activity
Make sure that the school personnel take a look into your child’s CGM or do a finger poke before recess and even Physical Education class (PE). I know that Amanda, does tend to go low every time she does some type of strenuous of physical activities.
A 504 plan is specifically designed for students who are at risk of not succeeding in school due to a disability covered under federal law.
Since your child has Type 1 Diabetes, he/she is covered under this federal law.
You need to advocate for your child to get the necessary accommodations in order for him/her to succeed in school.
At times you might need to educate school personnel in order for your child to get these accommodations. Do not give up, educate them. There is a lot of misinformation on social media/everywhere and this can get confusing.
Be a teacher towards your child’s school. Your child and your child’s school will appreciate it towards the end of the day.
If you think the school nurse needs more education on managing Type 1 Diabetes in children, you can refer them to the Sugar Surfing Training for Nurses website here. Dr. Ponder is a Pediatric Endocrinologist, who has Type 1 Diabetes himself, and he is AMAZING! He has a book called Sugar Surfing and it’s filled with knowledge.