Classroom Resource for Teachers
and Other Education Personnel
Although each person with diabetes requires an individualized nutrition care plan, many
things are similar among all people with diabetes. For example, monitoring of food intake
and physical activity, appropriate medication management, and glucose blood testing are
required by most individuals with diabetes.
It is increasingly important that all people employed in the field of education have a firm
understanding of diabetes, as well as the laws that protect students with diabetes.
Diabetes is a condition in which the body either does not create any insulin (type 1) or
does not produce enough insulin or use the insulin produced appropriately (type 2).
Insulin converts carbohydrate into energy. Many people with diabetes require insulin via
multiple daily injections or a continuous insulin pump.
Long-term complications of diabetes include:
 Heart disease
 Stroke
 Kidney disease
 Blindness
 Nerve disease
 Amputations
 Impotence
Section 504 Plan
This refers to Section 504 of the Rehabilitation Act of 1973. Parents of children with
diabetes have the right to develop a Section 504 Plan with their child’s school. Schools
can lose their federal funding if they do not comply with this plan. This means that a
child with diabetes must have the opportunity to participate in all school activities while
meeting their medical needs.
Children with diabetes have certain rights. A school cannot:
 Deny them the right to make the honor roll because of absenteeism
 Disallow credit for a course because of absenteeism
 Refuse to administer appropriate medication (schools are held liable for any negligence
or misuse of this medication)
Children with diabetes are permitted to participate in any sports and extracurricular
activities that they choose. The American Disabilities Act provides the same protection as
Section 504.
Items included in a Section 504 Plan might include the following, although many
variations and additions may exist based on the child’s unique position:
 The basis for the determination of disability, including the name of the child’s
physician/endocrinologist
 A description of how diabetes affects a major life activity
 The child’s optimal blood glucose range
 In addition, the following items are sometimes included in a Section 504 Plan:
– Unrestricted use of restrooms
– Unrestricted access to beverages and snacks
– Access to the school nurse during class
– Immediate access to diabetes-related self-management tools, including blood glucose
testing equipment, insulin, and glucagon
– Permission to perform blood glucose testing anywhere in the school, on the bus, on
field trips, or during extracurricular activities
– Permission to take tests at another time if experiencing hypoglycemia during regular
testing time
– Extra time to finish tests or activities if diabetes self-management takes up too much
of the scheduled time
– No penalization for tardiness or absenteeism related to diabetes
– Permission to wear medical alert bracelet at all times, including physical education
classes
– If parent(s) are unable to attend a school field trip, a school nurse or other trained
personnel will travel with the class
– The school will provide carbohydrate count information on all foods served in the
cafeteria
– A responsible adult will administer insulin, as necessary and as directed by a
physician (parents to ensure that all information is provided)
– Ketone checking is permitted, with assistance, as necessary, if blood glucose level is
above ____
– If the child cannot attend physical education classes because of hyperglycemia, this
will not affect the child’s grade
– If the child suffers a seizure or unconsciousness because of hypoglycemia, the nearest
trained adult will administer an injection of glucagon
Diabetes Medical Management Plan
This document is developed by the family and health care professional(s) and signed by
the health care provider(s). It describes the child’s diabetes care regimen, including:
 Date of diagnosis
 Current health status
 Emergency contact information
 Student’s willingness and ability to provide self-care
 List of diabetes equipment and supplies provided by the family and where to store these
items
 Signs and symptoms of hypoglycemia and hyperglycemia
 Orders, including those for blood glucose monitoring, insulin, glucagon, ketone
monitoring, and exercise
This plan is updated each school year and whenever any important changes take place.
The contents of the Section 504 Plan are based on the Diabetes Medical Management
Plan.
Individuals With Disabilities Education Act (IDEA)
IDEA mandates the federal government to give funding to education agencies to provide
free and appropriate education to qualifying students with disabilities. This includes
children with diabetes. The school must provide special education programs and related
services, and children must receive education in the least restrictive environment.
The school is required to develop an Individualized Education Plan (IEP), if it is proven
that diabetes can, at times, adversely affect educational performance. The team
developing this plan will include the parents, special education experts, and school staff.
The plan will outline how the student is expected to achieve specific educational goals.
Self-management of diabetes
Self-management includes:
 Blood glucose testing
 The consumption of food or the administration of insulin (via injection or by changing
insulin pump settings) and/or oral medication, if the results are out of range
Signs and symptoms of hyperglycemia
The most common causes of hyperglycemia include:
 Administering too little insulin
 Illness
 Stress or emotional upset
 Sudden decrease in amount of exercise
Symptoms of hyperglycemia include:
 Increased thirst
 Frequent urination
 Nausea
 Blurry vision
 Fatigue
Children with hyperglycemia need:
 To either administer insulin themselves or have a responsible adult administer it for
them
 Have permission to drink plenty of liquids in the classroom
 Have unlimited access to the restroom
 Have permission to test their own blood glucose or have it tested by someone else
frequently throughout the day
Note: Cognitive performance will decrease, often drastically, if a child has
hyperglycemia.
Signs and symptoms of hypoglycemia
The most common causes of hypoglycemia include:
 Administering too much insulin
 Skipping meals or snacks
 Exercising for longer or harder than planned
Symptoms of hypoglycemia include:
 A sudden change in behavior or temperament
 Becoming shaky, sweaty, pale, or lethargic
 Complaints of headache and weakness
Treatment of hypoglycemia includes:
 Treatment on the spot—never send a child alone to the nurse’s office
 A snack containing 15 grams of carbohydrate—a small piece of fruit, a handful of
crackers, or 4 fluid ounces of fruit juice
 A blood glucose check 10–15 minutes after the snack is eaten; if levels still are low,
repeat the snack and the testing until levels are normalized
Note: Some children will carry glucose tabs with them in case of hypoglycemia. Keep
these in the classroom, not in the nurse’s office.
In cases of severe hypoglycemia, the following may occur:
 Inability to swallow
 Seizure or convulsion
 Unconsciousness; if this happens:
– First, position the student on his/her side
– Contact the school nurse or other trained personnel
– Administer glucagon
– Call 911
– Then contact the child’s parents and physician
References and recommended readings
American Diabetes Association®. Safe at school statement of principles. Available at:
http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-atschool/safe-at-school/safe-at-school-statement-of.html. Accessed June 19, 2012.
Children With Diabetes®. Presentations. Available at:
http://www.childrenwithdiabetes.com/presentations/. Accessed June 19, 2012.
Children With Diabetes. Sample 504 and IEP plans. Available at:
http://www.childrenwithdiabetes.com/504/. Accessed June 19, 2012.
Children With Diabetes. The online community for kids, families and adults with
diabetes. Available at: http://www.childrenwithdiabetes.com/. Accessed June 19, 2012.
Meyers L. Safe at school. Diabetes Forecast [serial online]. May 2005:44-48. Available
at: http://www.diabetes.org/assets/pdfs/schools/safeatschool-forecast-article.pdf.
Accessed June 19, 2012.
Review Date 6/12
D-0555