School-age children spend about half their waking hours at school, and children with type 1 diabetes are no different. Since children can’t leave their diabetes at home when they go to school, having a plan — preferably a written plan — is necessary for managing their diabetes while they’re at school.
Such a plan should be individualized and should cover a child’s daily diabetes care as well as provide instructions for handling problems, emergencies and any unusual situations that may arise during the school day. Copies of the plan should be kept at school where teachers and other school personnel, such as the nurse, can access it easily.
What is type 1 diabetes?
Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the pancreas produces little or no insulin. Type 1 diabetes is also characterized by the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells.
When the body does not have enough insulin to use the glucose that is in the bloodstream for fuel, it begins breaking down fat reserves for energy. However, the breakdown of fat creates acidic by-products called ketones, which accumulate in the blood. If enough ketones accumulate in the blood, they can cause a potentially life-threatening chemical imbalance known as ketoacidosis.
Type 1 diabetes often develops in children, although it can occur at any age. Symptoms include unusual thirst, a need to urinate frequently, unexplained weight loss, blurry vision, and a feeling of being tired constantly. Such symptoms tend to be acute.
Diabetes is diagnosed in one of three ways – a fasting plasma glucose test, an oral glucose tolerance test, or a random plasma glucose test – all of which involve drawing blood to measure the amount of glucose in it.
Types of plans
One way to lay out your child’s diabetes management needs in school is the Diabetes Medical Management Plan (DMMP), developed by the American Diabetes Association and the National Diabetes Education Program. A DMMP gives instructions for managing your child’s diabetes and provides guidance for handling emergencies. In many cases, putting together a DMMP and discussing it with teachers and other school staff are sufficient to make sure your child’s diabetes-related needs are met during school hours.
Implementing a DMMP: If you’d like to implement a DMMP for your child, talk with your child’s healthcare team and include input from your child if he or she is old enough. Once the DMMP is developed, meet with school staff to discuss how the plan will be executed. The DMMP is to be reviewed and updated before each school year if your child’s treatment plan has changed, or if there is a change in the school schedule.
However, if you feel that your child’s diabetes is not being cared for properly under the DMMP, or if your child is being discriminated against because of his or her diabetes, (for example, if a gym teacher regularly prohibits your child from participating in gym activities for fear he or she will develop hypoglycemia), you may ask for a 504 plan to be developed.
Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits disability-based discrimination in all programs that receive or benefit from federal financial assistance. A 504 plan helps ensure that a child’s special needs are met, which may include extended time on tests, preferential seating, short breaks, etc.
A 504 plan is an agreement between a student and a school team, consisting of the principal, teachers and other school personnel, that the student will have full access to all school activities and will have his or her medical needs met. This type of plan is similar to a DMMP, but it is also legally binding, whereas a DMMP is not.
Typical provisions in 504 plans include: (Source: ADA)
• School staff trained on how to check blood glucose levels and administer insulin and glucagon.
• School staff trained to recognize high and low blood glucose levels, and respond appropriately
• Capable students are allowed to self-manage anywhere, anytime, and keep their diabetes supplies with them.
• Needed assistance is provided in the classroom to increase safety and decrease missed class time.
• Full participation in all sports, extracurricular activities, and field trips, with the necessary diabetes care assistance and/or supervision provided.
• Permission to eat whenever and wherever necessary, including eating lunch at an appropriate time with enough time to finish eating.
• Permission to take extra trips to the bathroom or water fountain.
• Permission for extra absences for medical appointments and sick days without penalty.
• Alternate arrangements for classroom time missed for medical appointments because of periods of high or low blood glucose, or illness related to diabetes.
If a student with diabetes has special education needs, an Individualized Education Plan (IEP) may be necessary, based on the DMMP for the student’s diabetes management routine. Rules and guidelines pertaining to IEPs are found in the Individuals with Disabilities Education Act (IDEA), which provides extra federal funding to state and local education agencies.
To qualify for an IEP, a child must have an impairment that affects his or her academic performance. A child who has had to miss many school days due to diabetes complications, and is doing poorly in class as a result, for instance, might qualify for an IEP. Under the law, an IEP must contain certain information, including the child’s current level of academic performance, the services that he or she is to receive, and an evaluation and revision schedule for the IEP. The plan should be created in collaboration with the child’s parents, healthcare team, teachers and perhaps the child, and it must be reviewed and revised yearly, although evaluations can be conducted more frequently.
If the parents are unhappy with the performance of the plan or if it no longer reflects the student’s needs, they can initiate a process to adjust the plan at any time. If, after revision, the parents still do not feel that the plan is adequate, they can refuse to sign it and try to reach an agreement or facilitate a change with the help of an outside source.
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 involving prior difficulties at school; or when a student is taking timed, standardized tests, or going through a transitional period such as a change of school or teachers.
Letting kids be kids
All children deserve a level playing field. A DMMP, 504 plan or IEP can help ensure just that. With the aid of the information and instructions laid out in one of these written plans and the legal recourse provided by a 504 plan or IEP, neither you nor your child will have to worry about lost opportunities or unfair treatment.
Want to learn more about how to help your child with diabetes at school? Read “Writing a Section 504 Plan for Diabetes,” “Helping a Student-Athlete With Type 1 Diabetes,” and “Managing Type 1 Diabetes in College.”