Both a 504 plan and an IEP are formal, legal documents, which means the school is legally bound to implement the practices laid out by the plan. One or the other may be particularly useful in situations where there have been prior difficulties at school or when a student is taking timed, standardized tests or going through a transitional period such as a change of grades or teachers.
As stated earlier, however, many if not most students with diabetes do fine with just a DMMP, and putting together a DMMP is useful even if parents intend to pursue the option of a 504 plan or IEP.
What to include in a DMMP
A DMMP should outline the student’s plan for the daily management of his diabetes. This plan should be developed by the parents with help from the child’s diabetes health-care team and possibly with input from the student, depending on his age. It’s a good idea for the parents to plan an office visit with members of their child’s diabetes health-care team specifically to talk about the school diabetes management plan. Once the student’s parents and health-care providers have agreed on a plan, the parents should set up a meeting with the appropriate school staff to discuss how the plan will be put into effect. After the plan has been reviewed and accepted by all parties, copies should be made available to school staff.
The DMMP should include information on the following topics:
Contact information. Phone numbers for the student’s parents, other caregivers, and physician should be included on the DMMP.
Blood glucose monitoring. Blood glucose monitoring is a necessary part of maintaining blood glucose control. In addition to providing information about blood glucose levels under normal circumstances, monitoring can also let teachers, coaches, and the student himself know effects of exercise or sickness on blood glucose levels. Monitoring provides feedback about how well insulin is working and can be useful in seeing if an insulin dose has lowered a high blood glucose level or covered the carbohydrate eaten.
The plan should address the following questions:
- Who performs the blood glucose check?
- What type of meter is used?
- Where is the meter stored and used?
- Who writes down monitoring results, and where?
- How should parents be informed of blood glucose results and treatments?
- What are the blood glucose target ranges?
- What action is to be taken if the blood glucose level is outside the target?
- Are ketones to be checked?
- At what blood glucose level should ketones be checked?
- By whom should they be checked?
- What should be done with information on ketones?
Insulin. Whether insulin is given on a regular basis during the school day (such as at lunchtime every day) or just stored at school for particular situations (such as when the student’s blood glucose is greater than 300 mg/dl) is specific to each student’s needs. Very clear guidelines should be written in the diabetes plan with regard to usual and correction doses of insulin.
School staff should be informed of the following:
- What type(s) of insulin does the student take?
- Where is the insulin stored?
- How is the insulin dose determined?
- When is insulin administered?
- Who fills the syringe, dials up the dose, injects the insulin, or supervises the bolus from an insulin pump?
If the student is on an insulin pump, written directions for its operation are also necessary.
Meal planning. Information about food issues needs to be written in the diabetes plan. Teachers, the school nurse, and often cafeteria staff need to be aware of the student’s food requirements.