Back to School: Getting Type 1 Kids Ready for the FallThursday, July 24, 2014
Despite the fact that we are in the middle of summer in the United States, parents of school age children and teens should still be preparing for the school year now. Whether the child is newly diagnosed or are seasoned diabetes experts on their child's care, it's important for families to complete the proper health-related paperwork to ensure their child will safely mange their diabetes at school.
Every year, most schools require paperwork to be filled out by the healthcare professional treating a student with diabetes. Since many families will plan a quarterly diabetes appointment in the summer, it is best to be prepared to complete the necessary paperwork together at the visit. Below are explanations about the standard forms that are used in school.
Diabetes Medical Management Plan (DMMP)
This form is considered the main diabetes plan for each student with diabetes. It is the family’s responsibility to obtain this form from the school and bring it to their HCP to fill out and sign. It includes all aspects of the child’s diabetes care including if any assistance is needed. The DMMP should be updated annually or whenever the child's regimen, or diabetes responsibilities change. The DMMP includes:
- Meal planning. The form asks how many carbs per meals–I typically just write in “per family or child/teen” so it allows flexibility with the meal plan
- Planned physical activity. What should the blood glucose (BG) be before, during, and after. If the BG is below or above a certain level, what should be done: typically, I write in, if the BG is <70, child should eat this __ amount of carbs (individualized for each child), wait 30 minutes before participating. Since most gym classes will be over by then, the goal is to reduce the risk of hypoglycemia overall. So, if gym or recess is within 2 hours of any planned meal or snack doses, I have them cut that dose in half so they will be able to participate with the risk of hypoglycemia.
- Blood glucose monitoring. The DMMP has standard testing times in the document so the HCP can merely check the boxes of when testing should occur: before meals, before and/or after activity, if symptoms of hypoglycemia or hyperglycemia, and the HCP can add other times if needed
- Taking diabetes medicines. This includes insulin doses as well as any oral diabetes medications the individual is taking.
- Handling episodes of illness and of low and high blood glucose. Managing diabetes when traveling or on school field trips are also included on the form. I typically ask that the family bring the form in and we fill it out together so it is individualized to their needs. While there are many sample forms available online, many school have their own forms or allow the healthcare provider (HCP) to use their own.
Make sure you have the family ask the school if other forms are needed too. Many schools require the DMMP to be filled out as well as a Medication Authorization Form, which specifies doses for the types of medications that will be present at school. Insulin and glucagon are typical medications that require the authorization forms. Any time a treatment change is made, the schools tend to require an updated form be filled out by the HCP. With growing children, this may be a frequent endeavor, which can add a lot of paperwork to your day. On the DMMP, there is typically a section that authorizes the parents to make adjustments to the dosing without an HCP approval. I highly recommend that all HCPs give this authorization to cover themselves from having to fill out new forms every time a carb ratio or correction factor change is made.
A sample DMMP form can be found here.
Section 504 Plan
The 504 Plan is a document established to meet the requirements of a federal law that prohibits discrimination against people with disabilities, Section 504 of the Rehabilitation Act of 1973 (commonly referred to as "Section 504").
Section 504 applies to all public schools and to private schools that receive federal funds.The same plan would also be appropriate under another law that protects students with disabilities, the Americans with Disabilities Act (ADA). The ADA covers all public schools and all private schools except those run by religious institutions. But, if the religious institution receives federal funds it is also covered. So, some families may have to do a little digging in the institution’s annual report to identify if federal funds are received.
The 504 Plan is used to make sure the student with diabetes has the same access to education as other children. It is a tool to clearly define the responsibilities of the school, family and child regarding diabetes care. This plan also needs to be in place in order to obtain accommodations for all standardized tests.
Other accommodations include:
- Those in direct contact (teachers, coaches, bus drivers) with the student should be trained to identify hypoglycemia and hyperglycemia and treatment options;
- Train staff to check blood glucose levels and administer insulin and glucagon;
- Allow the child to test blood sugar level and treat in response to the result (have snacks available if low or dose with insulin if high;
- Locations for blood glucose testing and insulin administration (depending on level of independence, the classroom is a reasonable accommodation)
- Allowing full participation in all sports, extracurricular activities, and field trips, with the necessary assistance and/or supervision provided
- Eating when necessary, including eating lunch at an appropriate time with enough time to finish eating.
- Taking extra trips to the bathroom or water fountain if needed;
- Excused absences for medical appointments and sick days; and
- Academic adjustments for classroom time missed for medical appointments, testing, or because of periods of hyperglycemia or hypoglycemia,
A sample 504 plan can be found here.
Individualized Education Plan (IEP)
Students who qualify for services under the Individuals with Disabilities in Education Act, also known as IDEA, will have an Individualized Education Program or IEP instead of a 504 plan. Typically, an IEP is more specific and focused than a 504 Plan, detailing the student's academic current level of functioning, needs, supports, and goals. Most children and teens with diabetes will not qualify for services under IDEA, unless they also have a second disability, such as a visual impairment, hearing impairment, or learning disability. Since IEPs are very detailed, most school districts will often use their own electronic form and is completed by a special education (also called resource teacher in some schools) case manager. Those who qualify for special education under IDEA are also covered by Section 504. However, a separate 504 plan is not needed since all the accommodations can be includes in the IEP.
Additional accommodations are available for standardized tests and college. This will be discussed in a separate, follow-up blog.