All students with diabetes need an individualized plan to address their health and safety needs in school settings. This plan may be a Section 504 accommodation plan or an Individualized Health Care Plan (IHCP) with an Emergency Care Plan (ECP) (see Appendix A).
According to Section 1 of Connecticut Public Act No. 12-198, “No local or regional board of education may prohibit blood glucose self-testing by children with diabetes who have a written order from a physician stating the need and the capability of such child to conduct self-testing. No local or regional board of education may restrict the time and location of blood glucose self-testing by a child with diabetes on school grounds who has written authorization from a parent or guardian and a written order from a physician stating that such child is capable of conducting self-testing on school grounds.” If permitted by local and regional boards of education, schools may accept written orders by advance practice registered nurses or physician assistants stating the need and the capability of children to conduct self-testing, including the time and location of blood glucose self-testing by a child with diabetes on school grounds.
The State Board of Education recommends that district policies regarding self-monitoring of blood glucose levels in school settings address the following issues:
- Determine a process for developing and implementing an individualized plan for the student:
- identify a core team to create the plan. This team should include, at a minimum, the school nurse, appropriate teacher(s), the student (if appropriate) and parent(s) or guardian(s) or other family members. Other possible members include the student’s health care provider, an administrator and other school staff;
- obtain current health information from the family and the student’s health care provider(s), including how often the child should monitor his or her blood glucose level;
- based on the student’s health status, determine the minimum frequency with which health information will be reviewed and updated; and
- clarify the roles and responsibilities of each member of the core team (see Appendix B).
- Define expectations for communication between relevant school staff, family and the student’s health care provider that includes:
- documentation by the student’s health care provider of health needs which may be included in appropriate authorizations for medications and procedures to be performed at school;
- written permission for school health staff to communicate with the child’s health care provider regarding diabetes management; and
- clear expectations for minimum frequency of communication.
- Address safety concerns, including:
- specific procedures for disposal of lancets and any material exposed to blood, which meet OSHA Universal Precaution standards;
- procedures for transportation of monitoring equipment;
- storage, security and access to monitoring supplies;
- identification of signs and symptoms of excessively high or low blood sugar levels and appropriate responses;
- emergency responses and plans;
- access to food and drink;
- replacement of equipment and supplies;
- considerations for safe self-monitoring on school grounds including:
- completion of a self-monitoring checklist and documentation of such assessment by the school nurse (see Appendix C);
- team discussion of the self-monitoring checklist;
- completion of a student agreement (see Appendix D); and
- accommodations during field trips, athletics and unusual circumstances such as lockdowns or building closures.
- Establish procedures ensuring that the appropriate people (including staff members such as teachers, physical education teacher, custodian, bus driver and substitute staff) are familiar with students’ 504 plan, IHCP and ECP and are properly “educated” regarding diabetes and the importance of timely treatment. This education should include:
- an understanding of diabetes;
- the signs and symptoms of high or low levels of blood glucose;
- emergency responses to low and high blood sugar levels;
- familiarity with blood glucose medications and equipment;
- location(s) for self-monitoring;
- possible adverse effects of high or low blood glucose levels on learning; and
- OSHA Universal Precaution standards.
- Ensure periodic assessments of the effectiveness of the individual plan, including review of the student’s competency level and changes in the school environment. Assessments should occur:
- at least annually with the school team, including the parents or guardians and when appropriate, the student; and
- more frequently if there are changes in the student’s diabetes management plan, changes in the self-monitoring abilities of the student or whenever an adjustment to the plan is appropriate. If the IHCP is separate from the Section 504 Accommodation Plan, then the team may make modifications to the IHCP without formal review of the 504 plan.
For more information, please contact Stephanie Knutson at 860-807-2108.