The years leading up to college include taking major exams, which influence students' college choices. Of course, this can lead to stress and blood glucose fluctuations.Therefore, when preparing for college board exams, families of students with diabetes need to take steps to obtain exam accommodations. Here is some information on how to do so.  

SAT, SAT Subject Tests, PSAT/NMSQT, or AP Exams
A request for accommodations must be sent and approved by Services for Students with Disabilities (SSD). In general, students approved by SSD for College Board testing accommodations meet the following criteria:
1. A Documented Disability. A letter from the physician treating the student with diabetes outlining that they treat the individual, when they were diagnosed and when the last office visit took place can be included.
2. Participation in a College Board Exam Is Impacted. The letter should also include a brief description of the individuals treatment regimen and that stress can cause fluctuations in blood glucose levels, leading to Only One Request Needed.  Once approved by the College Board, accommodations can be used on all of these exams:

• SAT and SAT Subject Tests

• PSAT/NMSQT

• AP Exams

3. Requested Accommodation Is Needed. The most common requests with diabetes:
•  Stop the clock testing to allow the individual to treat any flucutations in blood glucose (this requires a separate proctor, meaning the individual will be in a separate room than everyone else).  This is not a required accommodation.  I do have several patients who only request that they are allowed to bring their diabetes supplies into the exam with them.
•  Allowing all diabetes supplies (including food to treat hypoglycemia) to be available during the exam.
4. Accommodation Is Received on School Tests. With few exceptions, students who request an accommodation on College Board exams receive that accommodation on tests that they take in school. However, students who receive an accommodation in school, have an Individualized Education Program (IEP), or 504 Plan that includes the accommodation do not automatically qualify for the accommodation on College Board exams.

ACT Exam
The ACT is a little different than the SAT, PSAT, and AP exams. The individual has the option of choosing which accommodation fits their needs best:

1. National Standard Time with Accommodations. This allows the individual to take the exam at a regularly scheduled national test center under standard time limits but with accommodations within that center.  An example for diabetes is to obtain permission to eat snacks in the test room.
2. National Extended Time (50% time extension). Approved students taking the ACT (No Writing) have up to 5 hours total to work on all four multiple-choice tests at their own pace. Approved students taking the ACT Plus Writing have up to 5 hours and 45 minutes to complete all five tests. Both options include time for breaks between tests. This is the most common request for those with diabetes, including accommodations to bring in their diabetes supplies and snacks.

Testing Accommodations in College
Once in college, meeting with the disability services office will help obtain reasonable accommodations for diabetes care. While many of my patients do not want to register with their college’s disability office, it can be helpful, especially if an individual needs to reschedule an exam due to severe hypoglycemia. The professors will be more likely to make accommodations if documentation is already on file.

The same documentation typically used for 504 plans can also be used for college, but it does not always mean that all accommodations will be granted. It is advisable to submit a request well before starting the school year.  Some disability offices have deadlines within 2-4 weeks of the start of school. 

 Some typical accommodations (or modifications) may include:
•    Rescheduling exams if blood glucose levels are too high or too low
•    Extra breaks during exams for diabetes self-care
•    Allowing to bring food into class
•    Excused absences for sick days
•    Obtaining all carbohydrate information for food in the cafeterias in advance
•    If living in the residence halls, training the residence hall director or resident assistant regarding acute diabetes complications

It's important for students with diabetes be given the necessary time to accommodate for any disease management challenges that arise prior to or during exams. Being proactive about setting up these accommodations is paramount to guarantee these students are not left with an unfair advantage.

Resources for College Exams and Secondary Education
ACT Services for Students with Disabilities
SAT–College Board Services for Students with Disabilities
Going to College with Diabetes: A Self Advocacy Guide for Students
JDRF Toolkits


Check out Hess-Fischl's other school-related blog about organizing a diabetes medical management plan for students and how providers and families can get all the necessary forms prepared for the upcoming school year.