Advise Me

Going To School After A Type 1 Diabetes Diagnosis

Sending your child off on his or her first day of school can be daunting for any parent—but it may be particularly difficult if your child has recently been diagnosed with type 1 diabetes. Who will help with injections? What will happen on school field trips? Fortunately, a document called a 504 plan can help ensure school is a happy and healthy place for your child.

Children with diabetes are protected by federal law under Section 504 of the Rehabilitation Act of 1973, which provides special accommodations for students with type 1 diabetes. Rachel Calendo, CPNP, CDE, diabetes program manager at Banner Children’s, provides steps for developing a 504 plan to ensure your child thrives this school year.

Step 1: Ask for a Diabetes Medical Management Plan (DMMP)

Before approaching the school about a 504 plan, ask your child’s doctor for a DMMP. The DMMP outlines your child’s diabetes care needs at school, including target blood glucose levels, when or how often he or she should check blood glucose, symptoms of high and low blood glucose, how to treat hypoglycemia and insulin-to-carb ratios. You will use this as the basis for your 504 plans.

“Remember to request the DMMP (otherwise known as “school orders”) early,” Calendo says.  “Often it is helpful to get these orders at the last medical visit before school starts again. You can ask your child’s provider to keep a copy in the medical record, that way if the school loses it—it can easily be printed again."

Step 2: Assemble Your 504 Team

Schedule a meeting with the people who can help create the best 504 plan for your child. It can differ from one school district to the next, but the group typically consists of a 504 coordinator, the school nurse, your child’s teachers, the principal or vice-principal, school guidance counselor or social worker and your child’s health care provider. Your goal is to review your child’s eligibility and write a plan. Typical provisions include the following:

  • Trained personnel or school staff who can help recognize high or low blood glucose and can administer insulin and glucagon.
  • Stipulation if the child can self-manage anywhere, anytime and keep supplies with him or her.
  • Participation in sports, extracurricular activities and field trips and any supervision or assistance provided.
  • Even if drinks or food aren’t allowed in the classroom, the child should be given special accommodations to keep in class in case of low blood glucose.
  • If your child has a high or low BG at or during an exam, that he/she be allowed to postpone the testing until BG has returned to normal.

Calendo reminds parents to “keep in mind that the school is your partner in your child’s education and well-being during the school day. Ask for accommodations that are reasonable and pertain to your child’s specific situation. For example: Don’t ask for testing at your child’s desk if he or she is not independent with this task yet.”

Step 3: Sign and Document

After you and representatives from the school sign your child’s 504 plan, make sure you get a copy of the documents in writing or by email. It’s important to have the document on hand in case of emergency.

Step 4: Update Annually or As Needed

While a 504 plan should be updated annually, you can make changes at any time. For example, if your child learns how to give himself or herself insulin injections midway through the year, you can make that update. It’s recommended you have representatives sign the updated document.

“It is important to keep up with the 504 plan annually, even if you feel that all is going smoothly,” Calendo recommends. “This plan can follow your child to college. It may be helpful to have a precedent set for accommodations that are requested.”

If you move to a new school district, meet with the school and share the current 504 plan. Administration most likely will comply with the plan in place or you may need to rework it entirely.

Having Issues with the School?

There are many reasons schools fail to recognize 504 plans, but the most common is ignorance. If you are having difficulties putting a 504 plan in place at your child’s school, the ADA has legal advocacy staff who can help. For questions, call 1-800-DIABETES (1-800-342-2383).

Children's Health Diabetes Parenting