Unless directed specifically by orders from a student’s physician, the Cleveland School District will abide by the following plan of
care for diabetic students.
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Appropriate staff will be informed of those students who have diabetes in accordance with FERPA and HIPPA
regulations.
Parents/guardians of students with a diagnosis of diabetes will be required to complete a student health history form prior
to the beginning of the school year.
If available parents will submit a copy of the students medical orders.
At least 4 staff members at each school site will receive training in appropriate diabetic care and be designated as
Trained Diabetes Personnel (TDP) to work with students when a school nurse is not available.
When students are required to receive insulin while at school there are three options:
o A parent/guardian is permitted to come to school to administer insulin
o A student will be allowed to administer his/her insulin once they are recognized as Self-Directed
o A parent/guardian can instruct school personnel on how to give properly insulin
 Time will be allowed for the parent to provide this instruction to staff
One of the 4 TDPs will be on site with a diabetic student at all times, including extracurricular activities and school
sponsored field trips.
Any staff member not trained as a TDP that has primary care of diabetic student will receive modified training to include
a general overview of the disease and general diabetic health care.
All bus drivers transporting diabetic students will receive training and a copy of the student’s Quick Reference
Emergency Plan (QREP) and will be required to follow that plan.
Each diabetic student will have a Diabetes Medical Management Plan (DMMP) or an Individualized Health Plan (IHP).
Students will be allowed to eat regularly prepared meals; unless directed by physician’s orders.
The school nurse or TDP will work with the student and his/her parents/guardians to create a meal and snack schedule
following the DMMP/IHP that follows the regular school schedule as close as possible.
o The student may eat early if hypoglycemic.
o The student will have enough time to complete lunch.
o A snack or quick-acting form of glucose will always be immediately available to the student.
The DMMP/IHP will list snack times, what is considered to be a snack and when additional snacks should be given.
o The student will be allowed to have a snack whenever necessary.
Additional snacks will be provided by the parents/guardians.
The TDP will ensure the student has snacks and meals at the time of day listed on the DMMP.
Adjustments to snacks/meals will be allowed as needed in response to parent/guardian request.
Exercise and Physical Activity
 Students will be allowed to participate in all activities unless specified in the DMMP.
 Physical education teachers and coaches will have a copy of the students QREP and be expected to act in the case of a
diabetic emergency.
 The student’s glucose meter, water, and a fast acting carbohydrate source will be readily available at all times during
physical activities.
 A safe place will be provided for a student’s insulin pump if that student chooses to not wear it during physical activity or
exercise.
Water and Bathroom Access
 Students will be permitted to have immediate access to water, by either a water bottle at their desk or access to a
drinking fountain when needed.
 Bathroom breaks will be unrestricted.
Checking Blood Glucose Levels, Insulin and Mediation Administration, and Treating High or Low Blood Glucose
Levels
 A student’s level of self care is described by which tasks the student can do by himself/herself and which ones require
some assistance or the need to be completely performed by a TDP or school nurse.
o A Determination of Self-Directed Student form will be completed on each student.
 Blood glucose monitoring will be done at the times designated in the DMMP/IHP, when the student feels it necessary, or
when symptoms of hypoglycemia or hyperglycemia are seen or suspected.
 Diabetes medication including insulin will be administered by the appropriate route and person as stated in the
DMMP/IHP for scheduled doses and when needed for hyperglycemia.
 Privacy will be provided to the student when requested to check blood glucose levels or administer medication.
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Cleveland School District
November 30, 2010
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A student’s usual symptoms of high and low blood glucose levels will be listed on the DMMP/IHP.
When a student asks for assistance or is believed to show signs of altered blood glucose, the staff member will seek
assistance immediately from the TDP or school nurse. An adult will stay with the student at all times; NEVER send a
student with a suspected or actual high or low glucose level alone anywhere.
If any staff member finds an unconscious student the staff member will immediately contact the school office. The office
will be responsible for:
o Contacting the school nurse or TDP (if the school nurse is not onsite or readily available) to confirm
glucose levels using a monitor. Glucagon will be administered immediately even in the event a glucose
monitor is not available.
o Calling 911 (without waiting for school nurse or TDP to administer glucagon)
o Contacting the student’s parent/guardian and physician at the numbers listed on the DMMP/IHP
A safe place will be provided for a student’s insulin pump if that student chooses not to wear it during physical activity or
any other activity.
Field Trips and Extracurricular Activities
 The student will be included in school-sponsored field trips and extracurricular activities without limits as allowed by the
DMMP/IHP. Necessary supervision will be provided by a TDP or school nurse.
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A parent/guardian is not required to accompany the student.
Tests and Classroom Work
 If a student is affected by high or low glucose levels when a test is scheduled, the student will be allowed to take the test
at an alternate time.
 If a student requires a water break or bathroom break during a test or other activity, extra time will be allowed for the
student to complete the task.
 The student will be allowed to make up any classroom assignment missed due to diabetes care without penalty.
 Students will not be penalized for absences required for medical appointments and/or illness related to diabetes. The
parent/guardian will submit documentation from the treating health care professional.
COMMUNICATION
 A student’s health status will be kept confidential by school employees. The student may openly discuss his/her medical
condition if so desired.
 The student will be encouraged to take snacks on time and become self sufficient with diabetic care.
 The teacher, school nurse, TDP will provide reasonable notice to parent/guardian when there will be a change in planned
activities; exercise, playground time, field trips, lunch menu, or class parties to allow for changes in insulin, snack plans or
lunches for effected time.
 Substitute teacher and school nurses will be given a copy of a student DMMP/IHP and a list of the school nurses and
TDPs in the school.
EMERGENCY EVACUATION AND SHELTER-IN-PLACE
 In the event of an emergency situation/evacuation a student’s DMMP/IHP will remain in effect.
 The school nurse or TDP will provide diabetes care as outlined by the DMMP/IHP and be responsible for transporting the
student’s diabetes supplies and equipment.
 The school nurse or TDP will attempt to establish contact with the student’s parents/guardian and provide updates and
receive information related to the student’s care.
PARENTAL NOTIFICATION
 Parents will be notified immediately of the following situations:
o Symptoms of severe low blood sugar: continuous crying, extreme tiredness, seizure, or loss of consciousness.
o Blood glucose results below 40 or below 45 when 15 minutes has passed after having a fast acting
carbohydrate.
o Blood sugar over 275 or symptoms of high blood sugar: frequent urination, presences of ketones or vomiting.
o Refusal of a student to eat or take insulin injection or bolus.
o Any injury
o Malfunctions of an insulin pump that cannot be corrected.
o Parents will be required to pick up student if blood sugar is >300 after bolus of insulin.
EMERGENCY CONTACTS
 All students with diabetes will have on file current and correct numbers for:
o Parent/Guardian
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Cleveland School District
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o Alternate emergency names and phone numbers
o Student’s health care provider information
The school will be notified of any changes to the emergency information
DOCUMENTATION REQUIRED
The following documentation is required in the student’s file to facilitate appropriate care of the diabetic student.
All records are bound by HIPPA/FERPA confidentiality guide lines.
 DMMP/IHP – completed by school nurse, parent/guardian and health care provider
 Physician’s plan of care
 Training records for TDPs
 Quick Reference Emergency action plan (high/low)
 Low Blood Sugar Report (high/low)
 Blood sugar log
 Determination of self directed students
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Cleveland School District
November 30, 2010
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