U.S. Department of Health and Human Services

How Do You Plan Effective Diabetes Management in the School Setting?

  • Assemble a School Health Team
  • Review the Federal Laws
  • Assemble the Student's Health Care Plans
    • Diabetes Medical Management Plan (Prepared by the Student’s Personal Diabetes Health Care Team)
    • Individualized Health Care Plan (Prepared by the School Nurse)
    • Emergency Care Plans for Hypoglycemia and Hyperglycemia (Prepared by the School Nurse)
  • Prepare the Student’s Education Plan (As Needed)
  • Train School Personnel
  • Diabetes Management Training Resources
 

Assemble a School Health Team

Collaboration and cooperation are key elements in planning and implementing successful diabetes management at school. As is true for students with other chronic diseases, students with diabetes are more likely to succeed in school when the student’s school health team and the student’s personal diabetes health care team work together.

To work collaboratively, a school health team should be assembled that includes people who are knowledgeable about diabetes, the school environment, and Federal and State education and nursing laws. School health team members should include: the student with diabetes, the parents/guardians, the school nurse and other health care personnel, the staff members designated as trained diabetes personnel, administrators, the principal, the 504/IEP coordinator, office staff, the student’s teacher(s), the school psychologist or guidance counselor, the coach, and lunchroom and other school staff members.

The school health team is distinct from the student’s personal diabetes health care team. Members of this team include: the student with diabetes, the parents/guardians, and the student’s doctor, nurse, registered dietitian nutritionist, diabetes educator, and other health care providers involved in the student’s care.

The school health team members work together to implement the medical orders in the Diabetes Medical Management Plan (DMMP) developed by the student’s personal diabetes health care team, using the strategies outlined by the school nurse in the Individualized Health Care Plan (IHP). In addition, the school health team should be part of the group that develops and implements the student’s Section 504 Plan, other education plan, or individualized education program (IEP). These plans are developed to address students’ needs for services to manage diabetes safely and effectively in school, as required under Section 504 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act.

​Members of the School
Health Team
​Student with diabetes
​Parents/guardians
​School nurse
​Other school health care personnel
Trained diabetes personnel
​Administrators
​Principal
​504/IEP coordinator
​Office staff
​Student's teacher(s)
​School psychologist or guidance counselor
​Coach, lunchroom, and other school staff members
   
Members of the Student's Personal Diabetes Health Care Team
​Student with diabetes
​Parents/guardians
​Doctor
​Nurse
​Registered dietitian nutritionist
​Diabetes educator
Other health care providers involved with the student's care
 













 

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Review the Federal Laws

Three Federal laws address the school’s responsibilities to help students with diabetes:

  • Section 504 of the Rehabilitation Act of 1973 (Section 504)
  • Americans with Disabilities Act of 1990 (ADA)
  • Individuals with Disabilities Education Act (IDEA)

In addition, the Family Educational Rights and Privacy Act (FERPA) and IDEA protect the student’s privacy. FERPA and IDEA prohibit schools, with certain exceptions, from disclosing personally identifiable information in a student’s education record, unless the school obtains the prior written consent of the student’s parents/guardians or the eligible student (i.e., a student who is 18 years old or older or who attends an institution of post-secondary education). FERPA does not specifically afford unaccompanied minor students who are under 18 years of age and separated from a responsible adult the rights that are afforded to parents/guardians and eligible students under the law.  However, schools may use their judgment in determining whether an unaccompanied minor student who is under 18 years of age is responsible enough to exercise certain FERPA rights, such as inspecting and reviewing education records and providing written consent for the disclosure of education records, in addition to those given to his or her parents/guardians. See 34 CFR § 99.5(b).

These Federal laws provide a framework for planning and implementing effective diabetes management in the school setting, for preparing the student’s education plan, and for protecting the student’s privacy and access to appropriate care. The requirements of Federal laws must always be met. (See School Responsibilities Under Federal Laws) School administrators and nursing personnel also should determine whether there are applicable State and local laws and factor them into helping the student with diabetes at school.1

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Assemble the Student's Health Care Plans

Health care plans outline how each student’s diabetes will be managed. These plans help students, their families, school personnel, and the student’s personal diabetes health care team to know what is expected of each of them. These expectations should be laid out in writing in the following health care plans:

  • Diabetes Medical Management Plan (prepared by the student’s personal diabetes health care team)
  • Individualized Health Care Plan (prepared by the school nurse)
  • Emergency Care Plans for Hypoglycemia and Hyperglycemia (prepared by the school nurse)

Diabetes Medical Management Plan

The Diabetes Medical Management Plan (DMMP) (PDF, 223 KB), prepared by the student’s personal diabetes health care team, contains the medical orders tailored for each student. (See Tools for Effective Diabetes Management) The student’s health care provider should sign this plan. The DMMP is the basis for all of the health care and education plans designed to help the student manage diabetes effectively at school. Although the DMMP is not required by Section 504, ADA, or IDEA, the information it contains can be useful in addressing the requirements of these Federal laws for the student with diabetes.

The school nurse uses the information in the DMMP to develop the student’s Individualized Health Care Plan and the Emergency Care Plans for Hypoglycemia and Hyperglycemia. This information also should be incorporated into any Section 504 plan, other education plan, or IEP.

Information in the DMMP may include:

  • Date of diagnosis
  • Contact information (parents/guardians and student’s physician/health care provider)
  • Specific medical orders for checking blood glucose, administering insulin and other medications, and carbohydrate (carb) counting
  • Assessment of student’s self-care skills for performing diabetes care tasks
  • Typical signs, symptoms, and prescribed treatment for hypoglycemia and hyperglycemia
  • Assessment of student’s self-care skills for performing diabetes care tasks
  • Student’s diabetes equipment and supplies, including blood glucose meter, insulin delivery devices, glucagon, and continuous glucose monitoring systems (CGM)
  • Use of smartphone and/or other monitoring technology
  • Additional monitoring and treatment for ketones
  • Meal and snack plan
  • Physical activity
  • 72-hour disaster, lockdown, or emergency plan

The student’s personal diabetes health care team should complete and approve the DMMP before the student returns to school, immediately after diagnosis, or when a student transfers to a new school. The DMMP should be reviewed and updated each school year or upon a change in the student’s prescribed care plan, level of self-management, or school circumstances (e.g., a change in schedule) or at the request of the student or his or her parents/guardians.

Individualized Health Care Plan

The Individualized Health Care Plan (IHP) (PDF, 96 KB) is developed by the school nurse in collaboration with the student’s personal diabetes health care team to implement the student’s DMMP. (See Tools for Effective Diabetes Management) The IHP, sometimes called the nursing care plan, is based on the medical orders in the student’s DMMP and incorporates an assessment of the school environment as well as student-specific information (e.g., familial, psychosocial, and developmental information). Although the IHP is not required by Section 504, ADA, or IDEA, the information it contains can be useful in addressing the requirements of these Federal laws for the student with diabetes.

The school nurse uses the information in the DMMP and the nurse’s additional assessment findings to outline the diabetes management strategies and personnel needed to meet the student’s health goals. The school nurse reviews the IHP with the student and the parents/guardians before it is implemented and establishes a timeline to revisit the plan periodically to evaluate progress toward desired health goals throughout the school year.

Information in the IHP may include:

  • Plan for maintaining the student’s blood glucose within the target range specified in the DMMP (including strategies for blood glucose monitoring, administering insulin, treating hypoglycemia and hyperglycemia, adhering to the student’s meal plan, and participating in physical activity)
  • Supplies needed and where they will be kept
  • Use of smartphone, school phone, CGM, or computer to log data and/or to notify the school nurse or parents/guardians of blood glucose levels
  • Need for free access to the restroom and water
  • Nutritional needs, including provisions for meals and snacks
  • Participation in all school-sponsored activities and field trips, with coverage provided by the school nurse or trained diabetes personnel
  • Guidelines for communicating with the family and the student’s personal diabetes health care team
  • List of trained diabetes personnel and the diabetes care tasks they will perform
  • Plan and timeline for training and supervising trained diabetes personnel (see Train School Personnel)
  • Plan and timeline to train other school personnel (e.g., teachers, physical education instructors, food service, and transportation personnel – see Train School Personnel)
  • Timeframe for ongoing review of student outcomes
  • Strategies to ensure the student is not subject to inappropriate penalties for health care appointments and to provide accommodations during the school day
  • Plan for the student who independently manages diabetes at school
  • Maintenance of confidentiality and the student’s right to privacy

Emergency Care Plans for Hypoglycemia and Hyperglycemia

The Emergency Care Plans for Hypoglycemia (PDF, 96 KB) and Hyperglycemia (PDF, 97 KB) are based on the medical orders in the student’s DMMP. (See Tools for Effective Diabetes Management) The school nurse usually will coordinate developing these emergency plans. The plans for individual students summarize how to recognize and treat hypoglycemia and hyperglycemia and what to do in an emergency.

These plans should be distributed to all school personnel who have responsibility for students with diabetes throughout the school day and during school-sponsored activities.

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Prepare the Student's Education Plan (As Needed)

School health team members should be part of the group that plans how the DMMP will be implemented and be part of the group that determines the student’s eligibility under Section 504, the Americans with Disabilities Act, and/or IDEA. The school health team members should also be part of the group that determines the student’s needs for services to manage diabetes safely and effectively in school. The information collected about needed services should be included in any Section 504 Plan, other education plan, or IEP developed for the student and should be distributed to all school personnel who will be involved with implementing these plans.

  • A Section 504 Plan is the commonly used term for a plan of services developed under Section 504 of the Rehabilitation Act. For a student with diabetes, the plan would be developed and reviewed by a team that usually includes: the school nurse, parents/guardians, 504 coordinator, school administrator, school psychologist or guidance counselor, and teacher.
  • An IEP is required for students with disabilities who receive special education and related services under the IDEA. For a student with diabetes, the IEP would be developed and reviewed by the IEP team, including the parents/guardians; at least one regular education teacher and one special education teacher of the student; a qualified school district representative such as the IEP coordinator or school administrator; an individual who can interpret the instructional implications of the student’s needs; and, at the discretion of the parents/guardians or school district, other personnel with knowledge or special expertise regarding the student—usually the school nurse, school psychologist or guidance counselor, and/or trained diabetes personnel.

The information in the DMMP and IHP should be used in developing either a Section 504 Plan or an IEP, but it is not a substitute for these plans.

Individual students with diabetes have different needs, but their education plans are likely to address the following common elements:

  • Where and when blood glucose monitoring and treatment will take place
  • Identity of trained diabetes personnel—the staff members who are trained to perform or assist with diabetes care tasks such as monitoring blood glucose, administering insulin and glucagon, and treating hypoglycemia and hyperglycemia
  • Location of the student’s diabetes management supplies
  • Use of smartphone, school phone, insulin pump, CGM, or computer to log data and/or to notify the school nurse or parents/guardians of blood glucose levels
  • Need for free access to the restroom and water
  • Nutritional needs, including provisions for meals and snacks
  • Full participation in all school-sponsored activities and field trips, with coverage provided by trained diabetes personnel
  • Alternative times and arrangements for academic exams if the student is experiencing hypoglycemia or hyperglycemia
  • Permission for absences without penalty for health care appointments or prolonged illness
  • The opportunity to make up school work missed due to health care appointments or illness, including appropriate arrangements for meeting educational needs during or following an illness
  • Maintenance of confidentiality and the student’s right to privacy

It is strongly recommended that the information in the education plan be agreed upon before each school year begins (or upon diagnosis of diabetes) and be documented and signed by a representative of the school and the parents/guardians.

The student’s education plans help ensure that school personnel, the parents/guardians, and students know their responsibilities. The parents/guardians must be notified in a timely manner of any proposed changes in the provision of services and must be included in related discussions. (See School Responsibilities Under Federal Laws)

Plans for Diabetes Management
Plan Contents Who Prepares It
Diabetes Medical Management Plan (DMMP) Medical orders: all aspects of routine and emergency diabetes care Student’s personal diabetes health care team
Individualized Health Care Plan (IHP) School nursing care plan: how diabetes care, as prescribed in the Diabetes Medical Management Plan, will be delivered in the school School nurse
Emergency Care Plans
for Hypoglycemia and Hyperglycemia
Tool for school staff: how to recognize and treat hypoglycemia or hyperglycemia and what to do in an emergency School nurse
Section 504 Plan, other education plan, or Individualized Education Program (IEP) Education plans: address each student’s needs for services to manage their diabetes safely and effectively in school, where required under Section 504, the Americans with Disabilities Act, or the Individuals with Disabilities Education Act 504 team
IEP team
 
 

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Train School Personnel

 

Diabetes management training for school personnel is essential to facilitate appropriate care for students with diabetes. 

Trained school personnel can help to ensure that students with diabetes are safe, ready to learn, and able to participate in all school-sponsored events.

All school personnel should receive the appropriate level of diabetes care training suited to their responsibilities for students with diabetes.

 

When a school nurse is assigned to the school (or school district), he or she is the key school staff member who leads and coordinates the provision of health care services for a student with diabetes at school and at school-related activities. The school nurse, in collaboration with the principal, also takes the lead in identifying, training, and providing ongoing supervision of trained diabetes personnel. This will ensure that at least one trained diabetes personnel is available to provide care when a school nurse is not available.

 

Diabetes technology, therapies, and evidence-based practices are changing rapidly. The school nurse, who provides care to students with diabetes and facilitates diabetes management training for school personnel, has the professional responsibility to acquire and maintain current knowledge and competency related to diabetes management on a regular and ongoing basis.

Diabetes management training should be facilitated by a diabetes-trained health care professional such as the school nurse or a certified diabetes educator. Training should occur at the beginning of each school year and should be repeated when an enrolled student is first diagnosed with diabetes or when a student with diabetes enrolls in the school. Periodic refresher training is recommended.

 

Three levels of training are needed to keep students with diabetes safe at school. Training should be designed to include the elements outlined below using standardized training materials.

 

Level 1. Diabetes Overview and How to Recognize and Respond to an Emergency Situation

 

Level 1 training is for all school personnel and should cover:

 
  • An overview of diabetes
  • How to recognize and respond to hypoglycemia and hyperglycemia
  • Whom to contact for help in an emergency
 

Level 2. Diabetes Basics and What to Do in an Emergency Situation

 

Level 2 training builds on Level 1 and is designed for school personnel who have responsibility for the student with diabetes throughout the school day (e.g., classroom, physical education, music, and art teachers and other personnel such as lunchroom staff, coaches, and bus drivers).

 

Level 2 training should cover:

 
  • Content from Level 1 with specific instructions for what to do in case of an emergency
  • Roles and responsibilities of individual staff members (see Actions for School Personnel, Parents/Guardians, and Students)
  • Expanded overview of diabetes (types of diabetes, the role of blood glucose monitoring, and the importance of balancing insulin/medication with physical activity and nutrition and how it is done)
  • Procedures and brief overview of the operation of devices (or equipment) commonly used by students with diabetes
  • Impact of hypoglycemia or hyperglycemia on behavior, learning, and other activities
  • The student’s Individualized Health Care Plan, Section 504 Plan, other education plan, or IEP
  • The student’s Emergency Care Plans for Hypoglycemia and Hyperglycemia
  • How to activate Emergency Medical Services in case of a diabetes emergency
  • Tips and planning needed for the classroom and for special events
  • What to do during a schoolwide emergency (e.g., lockdown or evacuation)
  • Overview of the legal rights of students with diabetes in the school setting
 

Level 3. General and Student-Specific Diabetes Care Tasks

 

Level 3 training is for one or more school staff members designated as trained diabetes personnel who will perform or assist the student with diabetes care tasks when allowed by law. Level 3 training should be provided by a diabetes-trained health care professional such as the school nurse or a certified diabetes educator.

 

Level 3 training should cover:

 
  • All the information from Level 1 and Level 2 training
  • General training on diabetes care tasks specified in the student’s DMMP:
    • Blood glucose monitoring
    • Insulin administration
    • Glucagon administration
    • Ketone testing (urine and blood)
    • Basic carbohydrate counting
  • Student-specific training, when addressing each diabetes care task, includes:
    • Clear identification and understanding of the task as outlined in the student’s DMMP
    • Each student’s symptoms and treatment for hypoglycemia and hyperglycemia
    • Step-by-step instructions on how to perform the task using the student’s equipment and supplies
    • Clear parameters on when to perform the task, when not to do so, and when to ask for help from a health care professional
  • How to document that all care tasks performed
  • Plan for ongoing evaluation of trained diabetes personnel's performance
 

A school nurse, a certified diabetes educator, or another qualified health care professional with expertise in diabetes develops the instruction on performing the care tasks, provides for demonstration and return demonstration of the tasks, and evaluates the trained diabetes personnel’s competency. The school nurse establishes a plan for ongoing supervision to occur throughout the school year. The school nurse or other qualified health care professional also documents the instruction, competency evaluation, and ongoing supervision that are provided.

 

Diabetes Management Training Resources

 

There are many resources available for training school nurses and staff about diabetes management.

 
  • The National Association of School Nurses offers a live and online continuing education program for school nurses. This program, called Helping Administer to the Needs of the Student with Diabetes in School (H.A.N.D.S.SM), equips the school nurse with current diabetes knowledge and provides tools and resources to facilitate effective diabetes management for students at school. It is presented by a school nurse with a specific interest in diabetes and a certified diabetes educator.
  • The American Diabetes Association offers Diabetes Care Tasks at School: What Key Personnel Need to Know, a curriculum containing a set of training modules and corresponding DVD video segments. These materials are designed for use by the school nurse or other diabetes-trained health care professionals when training a school’s trained diabetes personnel. Training resources are also available.
  • The Joslin Diabetes Center's Diabetes Education Program for School Nurses offers a one-day program, designed by the American Diabetes Association and the Joslin Diabetes Center, to provide school nurses with up-to-date diabetes information to create a safe learning environment for students with diabetes.
  • JDRF offers the School Advisory Toolkit for Families, a guide which includes collaborative methods for educators and parents of children with type 1 diabetes to ensure that every child enjoys the best possible school experience.
  • A number of State programs have developed training curricula based on the American Diabetes Association’s curriculum, including California, Texas, and Virginia.
  • Some manufacturers of blood glucose meters, CGMs, insulin pens, and insulin pumps provide training materials, including apps specific to their products. Visit manufacturers’ websites for more information.
 

 

 

Diabetes Management Training for School Personnel

 

 

 

 

 
Level 1. Diabetes Overview and How to Recognize and Respond to an Emergency Situation ​ ​
​WHO: ​All School Personnel
​WHAT:
  • ​General overview of diabetes
  • How to recognize and respond to signs and symptoms of hypoglycemia and hyperglycemia
  • Whom to contact for help in an emergency
Level 2. Diabetes Basics and What to Do in an Emergency Situation​ ​
​WHO:                     Classroom teachers and all school personnel who have responsibility for the student with diabetes during the school day
​WHAT:
  • ​Content from Level 1
  • Specific instruction on the Emergency Care Plans for Hypoglycemia and Hyperglycemia
  • How to activate Emergency Medical Services in case of a diabetes emergency
  • Roles and responsibilities of individual staff members
  • Expanded overview of diabetes
  • Impact of hypoglycemia or hyperglycemia on behavior and learning
  • Tips and planning needed for the classroom and for special events
  • The student’s health care and education plans
  • Legal rights of students with diabetes
Level 3. General and Student-Specific Diabetes Care Tasks​ ​
​WHO: Trained Diabetes Personnel
​WHAT:
  • ​Content from Level 1 and Level 2 training
  • General training on diabetes care tasks specified in the student’s Diabetes Medical Management Plan
  • Student-specific training, using the student’s equipment and supplies for each diabetes care task

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1.State and local laws, including those concerning who can administer medications, cannot interfere with the rights of students with disabilities guaranteed by Section 504 and the ADA.

September 2016
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