Type 1 Now Conference

I’ve never moderated before….diabetes and school – 504s

I am not an overly confident person all of the time. I rarely say “No” if asked to do something even if I am scared that I won’t do it well or have no idea where or how to get started. In the end I normally surprise myself and am successful at the task I was assigned. Still – I have been sitting at my computer much of the day working out exactly what I want to provide to parents while I moderate a lunch time table talk regarding school and diabetes.

I know what I insist on having listed in my kiddos 504 plans. But do I have the right stuff, the best stuff, too much stuff, not enough stuff? I have checked every online reference I could find regarding writing a 504 for a student with diabetes. I have been pleasantly surprised at how much help is available to parents and schools regarding 504s for cwd. I hadn’t thought to look when I was writing my daughters first 504. I knew what a 504 was because of my education background so I just included everything I felt would keep my daughter safe and provide a “normalish” academic setting for her. Turns out I had included 99% of what others online suggest to include. I missed the part where I would insist bus drivers be trained in emergency care (kinda a big thing for me to miss now that I think about it.)

At the lunchtime talk I hope to provide parents with sample 504s. So many parents that I have mentored want a fill in the blank form. I discourage parents from trying to find a fill in the blank form since each child and every school is different. A 504 is an individualized plan – but not to be confused with an IEP (individualized education plan) – that may potentially also be handy if the student has learning difficulties but is not part of the 504 plan. (Sorry digressed)

I will have a list of important 504 items to include – as seen below:

Items to include in student with diabetes 504

(Some items may not apply due to age/understanding of the student – 504 items not limited to this list)

·         Blood sugar tests prior to ALL assessments including state exams (specify the target blood glucose levels that are acceptable to begin an assessment – I use 80-180.)

·         Unrestricted bathroom use

·         Unrestricted access to water

·         Snacks permitted outside normal snack time if blood glucose level deems necessary – snacks to be consumed in the classroom setting to reduce missed academic time if blood glucose levels permit.

·         Unrestricted access to nurse

·         Unrestricted access to testing supplies

·         Authorized to keep cell phone on person at all times

·         Trained personnel to recognize high and low blood sugar symptoms as well as provide basic and emergency medical care including testing blood sugars and administering insulin and glucagon: teachers, office staff, coaches & bus driver(s)

·         Adhere to doctors orders regarding who (child or adult) can administer insulin, count carbohydrates and test blood glucose levels – also note where the above actions should take place (nurse’s office, classroom, cafeteria – the bathroom is NOT acceptable)

·         Additional time to complete assignments or tests that were missed due to diabetic issue

·         Typed class notes for all instructional time missed due to diabetic issue

·         Trained medical adult to attend all field trips if parent cannot attend

·         Permission for parent/guardian to attend field trips and ride bus if necessary

·         Insuring full participation in all sports and extracurricular activities is allowed and necessary assistance or supervision is provided.

·         Eating whenever and wherever is necessary including eating lunch at an appropriate time with enough time to finish eating

·         Permitting extra absences for medical appointments and sick days when necessary

·         Require the school (nurse) to keep a daily log of blood glucose checks, carbohydrate intake, and insulin bolus amounts – this can be maintained at the school for parent or nurse reference or requested to be sent home daily/weekly/monthly.

·         Teacher(s) will provide all substitutes with a folder containing information regarding diabetes, student’s blood glucose testing schedule, symptoms of high and low blood glucose, and emergency procedures

·         School nurse will be notified at the start of the school day if a substitute is teaching in the student’s class.

As well as sample letters to substitutes – also seen below – substitutes do not have access to 504 plans so it is important to provide the information in a separate folder used by substitutes.

Insert picture of child here

Hello my name is ______________.

I have Type 1 diabetes.

I will go to the nurse a few times during the day to check my blood sugar and receive insulin. In the afternoon I will need to check my blood sugar prior to boarding the bus to go home. If my blood sugar is questionable I may need to eat a snack before getting on the bus. I may also need to use the bathroom more often than other students and consume more water than other students.

If my blood sugar is low I cannot be left alone.If I tell you that I feel low I will need to go to the nurse and a classmate or adult will need to escort me. The other student will not need to wait at the nurse’s office with me. On rare occasions I may be severely low (hypoglycemia) and may become disorientated, if that happens please call the nurse to the classroom immediately and if I am coherent enough give me a juice to drink while waiting for the nurse. Symptoms that might suggest that my blood sugar is very low are: pale skin, glossy eyes, inability to concentrate, shakiness, and dizziness. If you suspect that I am experiencing any of these symptoms please send me to the nurse or call the nurse. If I am low I will need to eat/drink fast acting carbohydrates such as juice or glucose tabs which I keep in the nurse’s office and in the classroom. I will have to stay in the nurse’s office until my blood sugar is at a safe level, usually about 15 minutes. Likewise I might at times have a high blood sugar (hyperglycemia). Symptoms of hyperglycemia are headaches, stomach aches, increased need to use the bathroom, and overall crankiness. In cases of high blood sugars I will need to go to the nurse to receive insulin and test my urine to be sure I do not have dangerous levels of Ketones. I usually will not have to stay in the nurse’s office after receiving insulin.

My blood sugar levels play a large role in my ability to think straight, for this reason it is important I test my blood sugars about 15 minutes before taking any tests or participating in any assessments.

I can eat anything my classmates eat. I do not have a restricted diet as a Type 1 diabetic. I just have to take insulin for all carbohydrates I eat. Thus, if we have special birthday treats or classroom treats outside our normal snack time I will have to take my blood sugar before eating them.

  – Blood Sugar testing schedule: (Times are examples and should be adjusted according to your child’s schedule)

·         8:30ish – AM Check

·         11:00 – Lunch Check

·         12:50 – Specials (PE, Music, Theater Arts, Art) check

·         2:35ish – PM Check

·         If you have any question you can ask me, call the nurse or call my mom.

·         Mom: _______________________ Phone #_______________________

·         Dad: ________________________ Phone # ______________________

 Also I plan to provide what I call the “Odds and Ends” – suggestions that will help keep the child safe and foster a good relationship between the teacher(s) and parent(s). Seen Below:

Odds and Ends

·       Be sure each teacher/classroom has fast acting carbohydrates available. I put a couple juice boxes and a tube of frosting in a ziplock bag for each teacher to keep handy.

·       Provide an alarm clock for students that stay in a homeroom class for the majority of the school day. I provide an old iPhone that allows for multiple alarms. Alarms are set for various times throughout the school day that alert my son that it is time to test his blood sugar.

·       Provide spare supplies to the nurse.

o   Extra vial of test strips

o   Extra meter

o   Extra syringes

o   Ketone strips

o   Vial of insulin

o   Batteries for pump and meter

o   Extra infusion set if using pump

·       Provide snacks to nurse to keep in his/her office to treat lows or provide a carb cushion prior to PE or other strenuous activity

·       Provide a substitute folder for all teachers including: art, music, theatre arts, and PE.

If your reading this and you have experience either attending school with diabetes or have a child with diabetes that attends public school and you have additional suggestions regarding what information I could/should share please consider leaving a comment. I have learned so much from those who have gone before me – I am always learning and would love the opportunity to share all that I can with others walking the same path.

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