Student Name: Date of Birth: School: Grade:
Overview:
- has Type I (Juvenile) Diabetes. This is a condition in which the pancreas is unable to make insulin. Without insulin, the body cannot convert glucose (sugar) into the energy a person needs. To compensate for the lack of natural insulin, she wears an insulin pump (Animas Ping). We use her insulin pump to administer the correct doses of insulin to match the carbohydrates in the food she eats (bolus) and the amount her body needs without food (basal rates).
- Type 1 diabetes is a recognized disability that requires the accommodations and modifications set out in this plan to ensure that she has the same opportunities and conditions for learning and academic testing as classmates, with minimal disruption of her regular school schedule and with minimal time away from the classroom.
- basal rates and food boluses must be balanced with her meals, snacks and regular physical activity. To consistently achieve this balance, she must check her blood sugar frequently. Depending on the daily classroom schedule, will need to check her blood glucose level before snack, lunch, recess, and before and after physical education class, as well as when her body tells her blood glucose is low or too high. We will review her schedule for checking blood sugar and attach a current schedule to this 504 prior to the start of each school year.
- In addition to normal blood glucose monitoring through finger pokes, uses a Dexcom CGMS (Continuous Glucose Monitoring System). Her Dexcom (we call it Dexie) monitors sugar level every 5 minutes and displays the data on a receiver. This monitor will alert (beep) when glucose is too high (2 beeps), too low (3 beeps) or going down quickly (3 beeps). She will have this receiver with her at all times. The receiver will be a valuable tool in Diabetes care at school.
- Dexie (Dexcom CGMS receiver) is NOT waterproof. The transmitter attached to her arm is waterproof. If a water activity is planned, it would be necessary for the Dexcom receiver to be held by the teacher, away from the water.
- Blood glucose levels must be maintained in the 90-150 range for optimal learning and testing of academic skills.
- behavior is often directly related to her blood glucose levels. She can feel grumpy, angry, tired and sluggish when her blood glucose is high. She feels hungry when it is low. She can appear "out of it" when her blood glucose is low. When her blood glucose is either high, low, or changing rapidly, she can be more emotional than normal and/or appear angry or grumpy.
- When is excited and/or stressed, as in a testing situation, her blood glucose can potentially go up but usually goes down.
- An adult and back up adult(s) should be trained to 1) perform blood glucose monitoring and record the results; 2) take appropriate actions for blood glucose levels outside the target ranges as indicated in diabetes health care plan; 3)test the urine or blood for ketones when necessary and respond to the results of this test; 4) be trained in the administration of insulin and glucagon; 5) be responsible for and know the schedule of her meals and snacks and; 6) work closely with her parents to coordinate this schedule with that of the other students as closely as possible. This individual will also notify her parents in advance of any expected changes in the school schedule that effect meal times or exercise routines.
- parents will be happy to assist in the education on type 1 diabetes, which will include but is not limited to, instructional videos and literature.
Information/Communication
parents must be contacted for any of the following reasons: her infusion set comes out (insulin pump no longer connected to her body), her pump alarms and cannot be remedied, her blood sugar is less than 50, her blood glucose exceeds 300, she has ketones in her urine, she becomes nauseated, or if she begins vomiting.
- If a concern arises regarding health or academic progress as affected by diabetes, there will be no hesitation to arrange a meeting among appropriate school personnel and parents.
- Teacher’s sub folder will contain information regarding diabetes.
- parents will provide a note in her lunch box for daily communication with the teacher. The note will include the carbohydrate amounts in snack/lunch so the Teacher can calculate the appropriate amount to enter into pump. At least one of parents will always be available via telephone or e-mail.
- parents will send all supplies for her insulin pump, blood glucose monitoring, and ketone monitoring. They will provide juice boxes, fruit snacks, glucose tablets and Glucagon for treating hypoglycemia.
- will carry her diabetes supplies with her whenever she leaves the classroom. This bag will include the remote meter and all testing supplies. This bag will travel with to and from school each day.
Water and Bathroom Access
- shall be permitted to have access to water at all times, including keeping a water bottle in her possession.
- shall be permitted to use the bathroom without restriction.
- teacher will notify her parents if drinking or bathroom frequency seems excessive.
- parents will provide extra juice boxes/ snacks to be kept in the classroom for treatment of hypoglycemia, class parties, and snack times.
- parents will provide a note in her lunch box for daily communication with the teacher. The note will include the carbohydrate amounts in snack/lunch so the Teacher can calculate the appropriate amount to enter into pump. At least one of parents will always be available via telephone or e-mail.
- will be permitted enough time to finish her snacks and meals. She will require 10 minutes before her scheduled lunch time to go to the nurse/secretary or teacher for glucose monitoring and insulin administration. After her insulin is administered, she will need to begin eating as soon as possible to prevent hypoglycemia. She will require a minimum of 20 minutes to finish ALL of her lunch.
- It is IMPERATIVE that finish ALL of her lunch. lunch/snacks should NOT be cleaned up and thrown away until a school staff member confirms that has eaten everything. If she is resistant to finishing her meals/snacks, the school nurse/secretary or teacher should contact mom or dad for assistance.
- All school personnel will permit to eat a snack wherever she is (including, but not limited to: classrooms, gym, auditorium, school grounds, field trips, and school bus) whenever necessary to treat, prevent, or follow a hypoglycemic episode.
- should not be excluded from class celebrations, including birthday and holiday parties. She will need to receive insulin for the carbohydrates in the item(s) she eats/drinks prior to consumption. parents should be advised whenever unanticipated/extra insulin is given.
- Whenever possible, class celebrations should be scheduled around routine care to allow for optimal blood glucose monitoring.
Low Blood Sugar
- may appear tired, hungry, confused, “spacey“, whiney, uncooperative, combative, off balance/difficulty walking, or even say something like “I’m low” or “My tummy hurts” when her blood sugar is low.
- If appears to have a low blood sugar, the teacher will be contacted IMMEDIATELY so that blood glucose can be tested and treated as quickly as possible. If it is not possible to check blood glucose immediately, a juice box should be given under the assumption that her blood sugar is low. Her blood glucose must be checked 10 - 15 minutes later to verify that it is over 100. If it is over 300, please contact parents for further instructions.
- When low blood sugar is suspected, must not be left alone. In the event of suspected low blood sugar, with obvious warning signs, it is preferred that a trained staff member come to to check her blood glucose and treat her whenever necessary.
- DexCom is great at helping catch lows before they get dangerous, however, once her blood sugar starts dropping fast, DexCom will take up to 45 minutes to be accurate again. Therefore, it will be necessary to have her blood sugar checked by finger poke to verify low blood sugar, and again 10-15 minutes later.
- will keep a supply kit in her classroom that contains a blood glucose meter, glucagon, juice box, and other snacks to treat a low blood sugar. This kit will be provided by parents. This kit MUST accompany her every time she leaves the classroom including but not limited to special area classes, recess, library, the cafeteria and the restroom
- During a fire/tornado/lockdown situation, kit MUST accompany her from the building and/or to the safe spot
High Blood Sugar
- may feel thirsty, sluggish, hungry, have a headache, blurred vision, and/or need to urinate often when her blood glucose is high.
- Hyperglycemia (high blood sugar) should be monitored closely. Whenever blood glucose is over 300, the teacher should also check for ketones using the blood ketone strips.
- Lack of insulin supply, which can occur with a pump malfunction or an occlusion in the tubing or infusion site, may lead to diabetic ketoacidosis (DKA) within a few hours. Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated promptly.
Glucose and Ketone Checks
- The goal is to minimize disruptions in regular school schedule and minimize time away from the classroom.
- A extra blood glucose meter will be kept in the classroom and in the office.
- blood glucose will be checked when her cgm alerts that she either too high, too low, or dropping rapidly.
- Glucose checks will be administered according to the times in the medical protocol, any time feels her blood sugar may be high or low, and/or anytime an adult suspects blood sugar is high or low.
- will need to have her blood glucose levels checked; before snack, lunch, recess, and before and after physical education class, as well as when her body tells her blood glucose is low or too high. We will review her schedule for checking blood sugar and attach a current schedule to this 504 prior to the start of each school year.
Insulin
- All pump supplies will be kept in the office/diabetes bag.
- The secretary/teacher will use the Pump remote to calculate the bolus amount based on the carbohydrate information provided by parents.
- When administering insulin, the current blood sugar amount of “Insulin on Board” (IOB) should always be taken into consideration. This information can be found at the top of the Status Screen -2 from both the insulin pump and the remote. pump will calculate the recommended dose using the IOB information, regardless of whether or not the IOB was give for a correction or a carbohydrate bolus.
Field Trips and Extracurricular Activities
- will be permitted to participate in all field trips and extracurricular activities without restriction.
- The teacher will notify parents of field trip dates as early as possible.
- If possible, a parent will accompany on class field trips
- If a parent is not able accompany on a field trip, a nurse or someone who is qualified to administer all diabetes related care will accompany .
Disciplinary Action
- behavior is often related to blood glucose levels. She can feel thirsty, sluggish, hungry and might have abdominal pain, a headache, blurred vision, or need to urinate often when her blood glucose is high. She may appear tired, hungry, confused, “spacey”, whiney, uncooperative, combative, off/balance/difficulty walking or say something like “I’m low” when her blood glucose is low.
- If behaves in a manner that is out of character (I.e.disrespectful/belligerent/defiant, hard time staying in her seat, sleep, lethargic), her blood glucose must be immediately taken.
- Blood glucose level should fall within normal range (90-180) before disciplinary action is taken. Additionally, she shall not be subject to disciplinary action for the first 60 minutes following a blood sugar problem, as it is possible that her recovery could take an extended amount of time
Tests and Classroom Work
- will have access to school secretary whenever necessary and without restriction.
- Blood glucose levels should fall within normal range (90-150) for optimal learning and testing of academic skills. should never be subject to testing (standardized or otherwise) if her blood sugar is less than 80 or greater than 300.
- If is affected by high or low blood glucose levels at the time of regular or standardized testing, she will be permitted to take the test at another time without penalty.
- If needs to take breaks to use the water fountain or bathroom, perform a blood glucose test, or treat hypoglycemia or hyperglycemia during a test, she will be given extra time to finish without penalty.
- Similarly, If needs to take breaks to use the water fountain or bathroom, perform a blood glucose test, or treat hypoglycemia or hyperglycemia during class, she will be given extra time to finish classroom work without penalty.
- will not be penalized for absences or tardiness required for medical appointments, illness, visits to the office, or time necessary to maintain blood glucose control.
This plan shall be reviewed and amended at the beginning of each school year or more often if necessary.
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Lovebug’s Care
Cheat Sheet
*When to check Lovebug’s Blood Sugar
- if Dexie say’s she is < 70
- if she is going to eat a snack or meal
- if she says she feels low (crying, irritable, lethargic, etc.)
*What to do for blood sugar/no food
-Bg >70 (Dexie will beep if <70) - give juice box, or 3 glucose tablets. Wait 20 minutes and check Dexie to make sure number is going up or stead and # is >70. (>110 if playing outside) Do another finger check if needed
70-200 - do nothing
Greater then 300 - Call Tim or Heather and we will walk you through giving her a dose of insulin, if needed.
*What to do for blood sugar/with food
Bg >70 (Dexie will beep if >70) - have Audrey eat 3 glucose tablets…then wait 20 minutes and do a finger check. If number is greater then 70 and arrow on Dexie is steady (straight across) then she is okay to eat. If number is below 70 then give 2 more glucose tablets and do another finger check in 15 minutes. Make sure Lovebug doesn’t eat anything or isn’t too active while waiting for her blood sugar to come back up.
Greater the 70 - all food must be carb counted. We will either leave a sheet with amount of carbs for meal/snack or call/text Tim or Heather and we will tell you number of carbs.
*If Lovebug is unconscious or having a seizure (Low Blood Sugar reaction) …call 911...if you are able…give Glucagons (in red tube in diabetes bag) and give as a shot in Lovebug’s thigh.
*Phone Numbers:
Heather : Tim :
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I have Laynard tags, a Parent Letter, Instructions for Checking Blood Sugars and Directions for bolusing from the Medtronic Revel and OmniPod if you are interested.
*if you would like either of these please contact me at sweet2thesoul@gmail.com and I will gladly send you a copy. There is just too much to put on one page!
Lovebug’s Care
Cheat Sheet
*When to check Lovebug’s Blood Sugar
- if Dexie say’s she is < 70
- if she is going to eat a snack or meal
- if she says she feels low (crying, irritable, lethargic, etc.)
*What to do for blood sugar/no food
-Bg >70 (Dexie will beep if <70) - give juice box, or 3 glucose tablets. Wait 20 minutes and check Dexie to make sure number is going up or stead and # is >70. (>110 if playing outside) Do another finger check if needed
70-200 - do nothing
Greater then 300 - Call Tim or Heather and we will walk you through giving her a dose of insulin, if needed.
*What to do for blood sugar/with food
Bg >70 (Dexie will beep if >70) - have Audrey eat 3 glucose tablets…then wait 20 minutes and do a finger check. If number is greater then 70 and arrow on Dexie is steady (straight across) then she is okay to eat. If number is below 70 then give 2 more glucose tablets and do another finger check in 15 minutes. Make sure Lovebug doesn’t eat anything or isn’t too active while waiting for her blood sugar to come back up.
Greater the 70 - all food must be carb counted. We will either leave a sheet with amount of carbs for meal/snack or call/text Tim or Heather and we will tell you number of carbs.
*If Lovebug is unconscious or having a seizure (Low Blood Sugar reaction) …call 911...if you are able…give Glucagons (in red tube in diabetes bag) and give as a shot in Lovebug’s thigh.
*Phone Numbers:
Heather : Tim :
**********************************************************************************
I have Laynard tags, a Parent Letter, Instructions for Checking Blood Sugars and Directions for bolusing from the Medtronic Revel and OmniPod if you are interested.
*if you would like either of these please contact me at sweet2thesoul@gmail.com and I will gladly send you a copy. There is just too much to put on one page!
