What Key Personnel Need to Know Diabetes Care Tasks at School: DIABETES BASICS

What Key Personnel Need to Know Diabetes Care Tasks at School: DIABETES BASICS
Diabetes Care Tasks at School:
What Key Personnel
Need to Know
DIABETES BASICS
Overall Goal:
Optimal Student Health and Learning
Monitoring
Blood
Glucose
Ketones
Glucagon
Health
Administration
&
Learning
Insulin
Regimen
Hypoglycemia
&
Hyperglycemia
Legal
Rights
Exercise
Nutrition
2
Learning Objectives
Participants will learn:

What is diabetes?

Why care at school is required

Basic components of diabetes care at school

Short and long term consequences of diabetes
3
What is Diabetes?
Body does not make or properly use insulin:



no insulin production
insufficient insulin production
resistance to insulin’s effects
No insulin to move glucose from blood into cells:
high blood glucose means:
fuel loss = cells starve
short and long-term complications
4
Type 1 Diabetes
 auto immune disorder
 insulin-producing cells destroyed
 daily insulin replacement necessary
 age of onset: usually childhood, young adulthood
 most prevalent type of diabetes in children
and adolescents
5
Type 1 Diabetes
ONSET:
SYMPTOMS:
CAUSE:
relatively quick
increased urination
tiredness
weight loss
increased thirst
hunger
blurred vision
uncertain, likely both genetic and
environmental factors
6
Type 2 Diabetes
 Insulin resistance – first step
 Age at onset:


Most common in adults
Increasingly common in children


7
overweight
inactivity
Type 2 Diabetes
ONSET:
SYMPTOMS:
in children
variable timeframe
tired, thirsty, hunger,
increased urination
some children show no
symptoms at diagnosis
8
Diabetes is Managed,
But it Does Not Go Away.
GOAL:
To maintain target
blood glucose
9
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
10
BG
Diabetes Management
Proactive
Reactive




keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
11
Assistance in
Diabetes Management
Routine Care:
 Many
students will be able to handle all or
almost all routine diabetes care by themselves
 Some students, because of age, developmental
level, or inexperience, will need help from
school staff.
Urgent Care:
 Any
student with diabetes may need help with
emergency medical care.
12
Care in the Schools:
School Nurses and Others
Nurse most appropriate to:


Supervise diabetes care
Provide direct care (when available)
However, a nurse is not always available.
Non-medical school staff can be trained to assist students
 For both routine and emergency care
 Including insulin and glucagon injections
13
Diabetes Medical Management Plan

A Diabetes Medical Management Plan (PLAN) should be
implemented for every student with diabetes.

PLAN is


developed by the student’s personal health care team and family and signed
by a member of student’s personal health care team
implemented collaboratively by the school diabetes team, including:
school nurse
the student
parents/guardians
other school personnel

14
Elements of a PLAN
 Date of diagnosis
 Emergency contact information
 Student’s ability to perform self-management tasks at school
 List of diabetes equipment and supplies
 Specific medical orders for blood glucose monitoring, insulin,
glucagon, and other medications to be given at school
 Meal and snack plan
 Exercise requirements
 Actions to be taken in response to hypoglycemia and
hyperglycemia
15
Quick Reference Plan

Development based on information from
students PLAN

Summarizes how to recognize and treat
hypoglycemia and hyperglycemia

Distribute to all personnel who have
responsibility for students with diabetes
16
Where to Get More Information
American Diabetes Association
1-800- DIABETES
www.diabetes.org
National Diabetes Education Program/NIH
www.ndep.nih.gov
17
Diabetes Care Tasks at School:
What Key Personnel
Need to Know
HYPOGLYCEMIA
AND
HYPERGLYCEMIA
Learning Objectives
Participants will learn:
 Symptoms
of high and low blood glucose
 Short- and long-term risks
 Treatment of high and low blood glucose
 Prevention of high and low blood glucose
19
Vocabulary
Glucose--a simple sugar found in the blood. the fuel that all body
cells need to function
HYPOglycemia--a LOW level of glucose in the blood.
Quick-acting glucose--foods containing simple sugar that raise
blood glucose levels
Glucose tablets or gel--special products that deliver a pre-measured amount
of pure glucose.
Glucagon--a hormone given by injection that raises the level of glucose
in the blood.
Carbohydrate--source of energy for the body.
20
HYPOglycemia
= LOW sugar
Onset:
–
–
–
sudden,
may progress to unconsciousness if not treated
can result in brain damage or death
The PLAN should specify signs and action
steps each level of severity:
–
–
–
mild
moderate
severe
21
Hypoglycemia:Risks & Complications

Greatest immediate danger

Not always preventable

Impairs cognitive and motor functioning

Early recognition and intervention can
prevent an emergency
22
Hypoglycemia: Possible Causes
● Too much insulin
● Too little food
● Extra physical activity
23
Hypoglycemia: Signs & Symptoms
Mild Symptoms
Hunger
Sleepiness
Shakiness
Changed behavior
Weakness
Sweating
Paleness
Anxiety
Blurry vision
Dilated pupils
Increased heart rate/palpitations
Moderate to Severe Symptoms
Yawning
Confusion
Irritability/frustration
Restlessness
Extreme tiredness/fatigue
Dazed appearance
Inability to swallow
Unconsciousness/coma
Sudden crying
Seizures
24
Mild Hypoglycemia: What to do
● Intervene promptly. Follow PLAN.
● Verify with blood glucose test when available.
● When in doubt, always treat. If no meter is available,
treat immediately.
Have student eat or drink fast acting carbs (15g)
– Test blood glucose 10-15 minutes after treatment
– Repeat treatment if blood glucose level remains low or if
symptoms persist per PLAN
– If symptoms continue, call parents per PLAN
25
QUICK ACTING GLUCOSE
Treatment for Lows: 15 g Carbohydrate
● 4 oz. fruit juice
● 15 gm glucose tablets (2-3 tablets)
● 1 tube of glucose gel
● 1-2 tablespoons of honey
● 6 oz. regular (not diet) soda (about half a can)
26
Severe Hypoglycemia
Rare, but life threatening, if not treated promptly:
● Place student on his or her side
● Inject glucagon, per student’s PLAN
● Never attempt to put anything in the student’s mouth
● Call 911, then parent/guardian
● Student should respond in 15 to 20 minutes
● Remain with the student until help arrives
27
Hypoglycemia: Prevention
●Keep a quick-acting sugar source with the
student. ALWAYS.
●Treat at onset of symptoms
●Eat, Insulin, Test, Exercise ON TIME.
●Ensure reliable insulin dosing, per PLAN.
●Ensure insulin dosing matches food eaten.


Watch picky eaters
Provide nutritional information to families
28
Hypoglycemia: Prevention
●Consult with parent/guardian when snack, meal
or exercise times must be changed.
●Monitor blood-glucose variations on gym days,
an extra snack may be required ½ hour before
gym or during prolonged vigorous exercise per
PLAN.
●A student should never be unattended when a
low blood glucose is suspected.
29
Vocabulary
Hyperglycemia too high a level of glucose in the blood.
Ketones (ketone bodies) Chemicals that the body makes
when there is not enough insulin in the blood and the
body must break down fat for its energy.
Diabetic ketoacidosis (DKA) the build up of ketones in
the body that can lead to serious illness and coma.
Ketone testing a procedure for measuring the level of
ketones in the urine or blood.
30
HYPERglycemia = HIGH Sugar
● Too much sugar in the blood, but cells are starving
● Onset:
–
–
Severe hyperglycemia is usually slow to develop
Can be rapid with pumps
● Hyperglycemia due to insufficient insulin may lead
to diabetic ketoacidosis (DKA) if not treated
(mainly in type 1)
● PLAN should specify signs and action steps at each
level of severity:
–
–
–
Mild
Moderate
Severe
31
Hyperglycemia: Risks & Complications
● Hyperglycemia due to inadequate insulin
can lead to DKA and/or coma or death
(mainly in type 1).
● Interferes with a student’s ability to learn
and participate.
● Serious complications develop when
glucose levels remain above target range
over time or are recurring.
32
Hyperglycemia: Possible Causes
●
●
●
●
Too little insulin
Expired insulin
Food not covered by insulin
Decreased physical activity
● Illness, injury
● Stress
● Other hormones
● Menstrual periods
● Any combination of the above
33
Hyperglycemia: Possible Signs &Symptoms
Severe Symptoms
Labored breathing
Very weak
Confused
Unconscious
Moderate Symptoms
Dry mouth
Vomiting
Stomach cramps
Nausea
Mild Symptoms
Lack of concentration
Thirst
Frequent urination
Flushing of skin
Sweet, fruity breath
Fatigue/sleepiness
Blurred vision
Increased hunger
Weight loss
Stomach pains
34
Hyperglycemia: What to do
Goal: lower the blood glucose to a target range.
Follow PLAN
•
•
•
•
•
Verify with blood glucose test.
Check ketones per PLAN.
Allow free use of bathroom and access to water.
Administer insulin per Recheck blood glucose per PLAN.
Call parents per PLAN.
35
Hyperglycemia: Prevention
● Eat, Insulin, Test, Exercise ON TIME.
● Reliable insulin dosing, per PLAN.
● Ensure that food eaten matches insulin dosing:
 Monitor food intake per PLAN
 Report binge eating
● Teachers consult parent/guardian prior to extra
snacks.
● Consult with parent/guardian when snack, meal, or
exercise times must be changed.
36
Hyperglycemia: Prevention
● Take appropriate action if a missed
dose is suspected or if an insulin pump
malfunctions.
● Avoid “over treating” low blood sugar
reactions.
● Respect the students; realize their limits
37
Practical Implications for Educators
● Students with hyperglycemia or hypoglycemia often do not
concentrate well.
● During academic testing:
 Check blood glucose before and during testing, per
educational plan.
 Access to food/drink and restroom.
 If a serious high or low blood glucose episode occurs,
students should be excused with an opportunity for
retake.
38
Practical Implications for Educators
● Students should have adequate time for taking
medication, checking blood glucose, and eating.
● “Make the right choice the easy choice” by
eliminating barriers to:
–
–
–
snacking
blood glucose testing
access to water and bathrooms
● Avoid making judgments based on individual
blood glucose readings.
39
Diabetes Care Tasks at School:
What Key Personnel
Need to Know
BLOOD GLUCOSE MONITORING
Learning Objectives
Participants will learn:
 Why blood glucose is monitored
 When blood glucose should be monitored
 How to perform a blood glucose check
41
Blood Glucose Monitoring
GOAL:
IMMEDIATE BENEFIT:
maintain blood glucose within target range.
maximize learning and participation.
prevention of lows and highs.
LONG-TERM BENEFIT:
CHALLENGE:
decrease risk of long-term complications
maximize health.
many variables can impact blood-glucose.
42
Role of the School
● Facilitate blood glucose monitoring per PLAN
● Act on blood glucose check results per PLAN
● Provide monitoring data to parent/guardian
43
Benefits of School
Blood Glucose Monitoring
● Enables maintenance of blood glucose levels
within target range for safety; promotes long
term health and optimal academic
performance
● Identifies factors that affect blood glucose
44
Any Time, Any Place Monitoring
For students who can self-check:
●
●
●
●
●
better blood glucose control
safer for student
student gains independence
less stigma
less time out of class.
45
Basic Steps
● Know the target range per PLAN
● Check at times specified in PLAN
● Immediate Action – Treatment to get back
within target range
46
When to Check?
● PLAN specifies for an individual student
Regularly scheduled checks:
 Routine
 Before,
monitoring before meals and snacks
during and/or after exercise
47
When to Check?
Extra checks may be necessary:
 Periods of stress or illness
 Hypoglycemia or hyperglycemia symptoms
 Change in diabetes management
–Insulin/medication doses
–Meal plan
–Activity
48
Lancing Devices
Lancets
Pen-type Lancing Devices
49
Know the Meter

–
–
–
–
–

250
Features vary:
Ease of use
Sample size needed
Wait time
Alternate-site testing capacity
Ability to reapply, if insufficient sample
Become familiar with the operation of each
student’s meter
50
53
Preparation
1. Gather blood glucose
monitoring supplies:
-Lancet
-Test strips
-Meter
2. Wash hands.
3. If assisting or performing for student,
put on disposable gloves.
51
Readying the Meter
4. Turn the meter on
5. Check code #
6. Insert a strip into the meter
52
Lancing the Finger
7. Hold the lancet device to
the side of the finger
and press the button to
stick the finger.
53
Applying Blood to Strip
8. Follow instructions included with the meter
when applying blood to strip
Drop,
not smear
Cover ALL of
test strip
window
54
Some strips
suck blood
onto the strip
Results
9. Wait until blood
glucose results
displayed.
250
10. Dispose of lancet
11. Record blood
glucose results, take
action per PLAN.
55
53
What does the display mean?
 Check
manual
 Contact
manufacturer (1-800; Website)
56
What does the number mean?
Reference student’s target range
 Individualized for student
 May vary throughout day
 Take action per PLAN
Communicate sensitively
57
INSULIN ADMINISTRATION
Learning Objectives
Participants will learn:
Types of insulin
Insulin delivery basics
Vial and syringe administration
Pen device administration
Pump basics
59
Insulin in Schools Today
● Many students need to take insulin in school
● Insulin regimens vary
● Need for assistance will vary.
● GOAL: Maintenance of blood glucose target range
60
Insulin Types
●
●
●
●
Rapid-acting – Humalog ®, Novolog ®
Short-acting - Regular
Intermediate - Lente, NPH
Long-acting - Ultralente,
Glargine (Lantus)
Storage:
● Refrigeration or store at room temperature
as specified by PLAN.
61
Delivery Methods
● Insulin Syringe
● Insulin Pen
● Insulin Pump
● Jet Injector
62
When to Give Insulin
Administer as specified by PLAN:
Generally:
● Before meals
● For blood glucose levels significantly
above target range
● For increased ketones
63
Dosing
For many students, insulin dose varies,
depending upon:
Blood glucose readings
 Food availability/preference
 Physical activity level
 Age/body weight

Follow prescribed guideline in PLAN.
64
Dosage Specifications
PLAN should specify conditions clearly.
● Dosage based upon insulin to carbohydrate
ratios for meals and snacks
● Correction dosage to treat hyperglycemia
65
Insulin Syringes
● Sizes – 30, 50, 100
units
● Disposal-
66
Syringe & Vial: Preparation
1. Get Supplies





Insulin (Verify)
Syringe
Alcohol wipe
Disposable gloves
Sharps container
67
Syringe & Vial: Preparation
2. Wash hands;
apply gloves
3. Clean the insulin vial
68
Syringe & Vial: Preparation
4. Have student select injection site.
5. Clean the injection site
69
Syringe & Vial: Preparation
6. Check the insulin dose
7. Remove the cap from syringe.
70
Syringe & Vial: Dosing
8. Pull the plunger down to number
of units to be administered.
9. Inject air into bottle.
71
Syringe & Vial: Dosing
10. Draw out prescribed
number of units of insulin
as per PLAN.
72
Check Dose
Syringe & Vial: Injecting
11. Pinch up the skin.
12. Push needle into skin at 90.
13. Release pinch.
14. Push the plunger in.
15. Count to “5”.
16. Remove needle and dispose
of syringe.
73
Insulin Pen: Devices
●Prefilled pens
●Reusable (cartridge) pens
Techniques for dose preparation and insulin
delivery are similar for both types of pen
devices.
74
Insulin Pen: Preparation
1. Gather supplies. Verify insulin type.
 pen device (with cartridge)
 pen needle
 alcohol wipe
 sharps container
2. Wash hands.
3. Chose injection site
4. Clean injection site
5. Screw on pen needle
75
Insulin Pen: Dosing
6. Prime: Dial “2” units.
7. Remove air by pressing the plunger. Repeat
“Prime” if no insulin shows.
8. Dial number of units to be administered as
per PLAN.
76
Insulin Pen: Injecting
9. Pinch up the skin.
10. Push the needle into the skin at 90
11. Release pinched skin.
12. Push down on the plunger.
13. Count to “5”.
14. Remove and dispose of pen needle.
77
Insulin Pump Therapy
● Based on what body does naturally

Small amounts of insulin all the time
(basal insulin)

Extra doses to cover each meal or snack
(bolus insulin)
● Rapid or Short-Acting Insulin
● Precision, micro-drop insulin delivery
● Flexibility
78
What is an Insulin Pump?
● Battery operated device about the size of a pager
● Reservoir filled with insulin
● Computer chip with user control of insulin
delivery
● Worn 24 hours per day
● Delivers one type of insulin
79
Sampling of Pumps
80
Insulin Pump
Manufacturers
● Animas Corporation
1-877-YES-PUMP (937-7867)
www.animascorp.com
● Medtronic MiniMed, Inc.
1-800-MINIMED (646-4633)
www.minimed.com

Disetronic Medical Systems, Inc.
1-800-280-7801
www.disetronic-usa.com

Deltec Cosmo
1-800-826-9703
www.deltec.com
81
Pump Supplies at School
● Infusion set
● Reservoir
● Insulin
● Skin prep items
● Alcohol wipes
● Syringe (in case of malfunction)
● Pump batteries
● Inserter (if used)
● Manufacturers manual, alarm card
82
After Giving Insulin
● Check site for leakage
● Correction doses:

Retest per PLAN
● Meal/snack doses:


Timeliness
Supervision of food amount per PLAN
83
KETONE MONITORING
Learning Objectives
Participants will learn:
 What ketones are
 Why ketones are monitored
 When ketones should be monitored
 How to perform a ketone test
 When to contact parent/guardian or student’s
health care provider
85
Why test for ketones?
● Ketones(acids) can build up and result in diabetic
ketoacidosis (DKA).
What is DKA?
● Acids that build up in body and cause student to feel ill
● Emergency state, can lead to coma, death.
● Common symptoms include fruity odor to breath, nausea,
vomiting, drowsiness
● Number one reason for hospitalizing children with diabetes
● Early detection and treatment of ketones prevents
hospitalizations
86
How to test urine ketones
1. Gather supplies
2. Student urinates in clean cup
3. Put on gloves, if performed by
someone other than student
4. Dip the ketone test strip in the cup
containing urine.
5. Wait 15 - 60 seconds
6. Read results at designated time
7. Record results, take action per PLAN
87
Test Results: Color code





no ketones
trace
small
moderate
large ketones present
88
Treatment of Ketones
PLAN specifies for an individual student.
Generally:
●
●
●
●
●
free use of bathroom
sugar-free liquids
insulin as per PLAN
no physical activity
if vomiting or lethargic, call parents
89
GLUCAGON ADMINISTRATION
Learning Objectives
Participants will learn:
What glucagon is
How glucagon should be stored
When glucagon is used
How to administer glucagon
91
What is Glucagon?
● Naturally occurring hormone made in the pancreas
● A life-saving, injectable hormone that raises blood
glucose level
● Treatment for severe hypoglycemia
● Can save a life
● Cannot harm a student
92
Glucagon Kit Storage
● Place: As designated in PLAN.
● Store at room temperature
● Expiration date: Monitor
● After mixing, dispose of any unused portion.
93
Emergency Kit Contents:
1 mg of freeze-dried glucagon (Vial)
1 ml of water for reconstitution (Syringe)
Combine immediately before use
94
When to Give Glucagon
If authorized by the student’s PLAN and if
student exhibits:
 Unconsciousness,
 Convulsions
 Inability
unresponsiveness
or seizures
to safely eat or drink
95
Procedure: Act Immediately
● Position student safely on side for comfort
and protection from injury
● Call 911, parents, school nurse as per PLAN
96
Preparation
1. Flip cap off glass vial
containing dry powder
2. Remove cap from syringe
97
Mixing Solution
3. Inject entire fluid in syringe into the
bottle containing powder
4. Shake gently or roll to mix until all
powder is dissolved and solution is
clear.
98
Drawing out
5. Inspect. Solution should be
clear and colorless.
6. Draw prescribed amount of
glucagon back into syringe.
99
Dosing & Injecting
7. Clean site if possible
8. Inject at 90° into the tissue under cleansed area, using the
same technique as an insulin injection (however, needle
is much larger than insulin syringe needle)
 buttocks
 thigh
 arm
100
After Injecting
11. May take 15-20 minutes for student to
regain consciousness.
12. Check blood sugar.
13. Give sips of fruit juice or regular soda,
once student is awake and able to drink.
14. Advance diet as tolerated.
15. Document as per PLAN
101
Don't be surprised if. . .
● Student does not remember being
unconscious, incoherent or has a
headache
● Blood sugar becomes very high (over
200)
● Nausea or vomiting occurs
102
NUTRITION AND EXERCISE
Learning Objectives
Participants will learn:
 Basic meal plans for students with diabetes
 Nutrition calculation methods
 Exercise benefits for students with diabetes
 Exercise guidelines for students with
diabetes
104
Nutrition: Why be concerned?
 Good nutrition is important for everyone
 Nutrition planning is essential for good diabetes
control:
 maintain blood-glucose within target range
 to prevent or delay complications
 to help children and teens grow and develop properly
105
School Nutrition Management

Student’s family and health care team
determine an individualized meal plan

Meals & snacks need to be carefully timed to
balance exercise and insulin/medications

Encourage healthy eating for all students
106
Basic Meal Plans
Key:

Most students have flexibility in WHAT to eat.




Balance insulin/medications
with carbohydrate intake
Exchange System
Basic Carbohydrate Counting
Advanced Carbohydrate Counting
Many students have flexibility in WHEN to eat.
 More precise insulin delivery (pumps, pens)
 New insulins
107
Basic Carbohydrate Counting

Calories from:

carbohydrate

protein

fat

Each nutrient type affects blood sugar differently.

Carbohydrate has the biggest effect on blood sugar.

TOTAL carbohydrate matters more than the source
(sugar or starch.)
108
Advanced Carbohydrate Counting
USING THE INSULIN-TO-CARB RATIO
The insulin-to-carb ratio:
Varies from student to student.
 Is determined by the student’s health care team
 Should be included in the PLAN

109
School Meals & Snacks

Provide school menus and nutrition
information to student/family in
advance

Provide sufficient time for eating

Monitor actual food intake per PLAN
 young, or newly diagnosed
 picky eaters
Respect, encourage independence

110
Beyond the Routine: School Parties
 Provide parent/guardian with advance notice of
parties/special events.
 Follow the student’s PLAN and 504 Plan or IEP
 Some students will prefer to bring their own foods.
 Provide nutritious party snacks to encourage
healthy eating habits for all.
111
What every student with diabetes
wants you to remember:
Sugar is NOT the Enemy
There is no justification for complete restriction of
sugar:

Sometimes sugar can be a life-saving friend!

However, timing matters a lot with diabetes, and
sometimes sugar (or any carbohydrate) is not a good
choice at all.
112
Beyond the Routine: Field Trips

Bring plenty of snacks to treat hypoglycemia.

Bring lunch as appropriate.

Consult with parent/guardian about food
and/or insulin adjustments for extra activity
level.

Bring diabetes equipment and supplies.

Bring list of emergency contacts
113
Exercise & Diabetes
Everyone benefits from exercise and physical activity.
Students with diabetes should fully participate.
In general, exercise lowers blood sugar levels.



May need to make adjustments to insulin/medications and food
intake.
A quick-acting source of glucose, glucose meter, and water
should always be available.
PE teachers and coaches must be familiar with symptoms of
both high and low blood glucose.
114
Exercise & Blood Glucose Monitoring
Check before, during, and after exercise per
PLAN.
 Especially when trying a new activity or sport
 If blood sugar starts to fall, student should stop and
have a snack
 Students with pumps may disconnect or adjust the basal
rate downward, in lieu of snacking (per PLAN)
115
Exercise & Insulin/Medication
Physical activity can raise blood glucose levels
if there is insufficient insulin.
follow PLAN for exercise restrictions when ketones
are present
Work with parent/guardian to determine the best
times for physical activity.
116
LEGAL CONSIDERATIONS
Learning Objectives
Participants will learn about:
Federal laws that protect students with
diabetes
Impact of state laws upon diabetes care in
the school setting
Recommendations for 504 Plan or IEP
118
Needs of children with
diabetes in school setting...
Eliminate Discrimination
● Equal access to educational and school related
opportunities.
Secure Care
● A medically safe environment for students
with diabetes.
119
Federal Laws: Equal Access
● Section 504 - Section 504 of the
Rehabilitation Act of 1973
● ADA - Americans with Disabilities Act
● IDEA - Individuals with Disabilities
Education Act
120
Federal Protections
● Prohibits discrimination against people with
disabilities by public schools and most private
schools that receive federal funds
● Students must be given equal opportunity
● Related aids and services are required to meet the
individual needs of a student with disability
121
Written Plans
●Educational needs:
 504
Plan
 IEP
●Health care needs:
 Diabetes
Medical Management Plan
(PLAN)
122
Needs Addressed by 504 Plan/IEP Plan
● Location and timing of blood glucose
monitoring
● Identity of trained diabetes personnel
● Location of diabetes supplies
● Free access to water and restroom
● Nutritional needs, meals and snacks
123
Needs Addressed by 504 Plan/IEP Plan
● Full participation in all school-sponsored
activities
● Alternative times for academic exams if
student is experiencing hypoglycemia or
hyperglycemia
● Absences without penalty for doctors’
appointments and diabetes-related illness
● Maintenance of confidentiality and student’s
right to privacy
124
State Laws & Regulations
● State and local laws and regulations vary
regarding who may perform various aspects
of diabetes care
● Become familiar with state and local laws
that impact school diabetes care
● Regardless of state and local law, the
requirements of federal laws must be met
125
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