The Superhero Goes to School/ 504 Plan

This is an experience that was only in the distance future, until THIS year! We decided (The Superhero actually decided), it was time for pre-school. He has been WAITING for school for over a year. He talks about it

So, here we are.

Here are some GREAT blog posts about school...

CandyHeartsBlog has some great info here. (I pretty much copied Sugar's 504 plan)

BetaBuddies has some info here, here, here, and here.

And here is the 504 Plan we have implemented for The Superhero...

504 Plan for __________

2010-2011 School Year


__________ 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, he wears an insulin pump (Animas Ping). We use his insulin pump to administer the correct doses of insulin to match the carbohydrates in the food he eats (bolus) and the amount his body needs without food (basal rates).

__________'s basal rates and boluses must be balanced with his meals, snacks, health, stress level, and physical activity. To consistently achieve this balance, he must check his blood glucose frequently (or have it checked). __________will need to have his blood glucose levels checked every 2 -3 hours (or more often as needed); including before snack, whenever an adult suspects a blood glucose problem, and whenever he alerts someone that he feels his blood glucose is too low or too high.  It may also be necessary to check his blood glucose level before, during and/or after physical activity, especially in situations of prolonged exertion.

__________’s target blood sugar range throughout the school day is 90 - 180.

While __________is learning some independence in self-management of his diabetes, the adults who work with him will need to be supportive and understanding about the daily regimen.  At this time, he is unable to perform his diabetes care independently.  His self-care needs will be integrated into the school day in an attempt to provide minimal interruptions of the learning environment. 

In addition to normal Blood Glucose monitoring through finger pokes, __________ uses a Dexcom CGMS (Continuous Glucose Monitoring System). His Dexcom (we call it Dexie) monitors __________’s sugar level every 5 minutes and displays the data on a receiver. He will have this receiver with him at all times. The receiver will be a valuable tool in __________’s Diabetes care at school.

Dexie (Dexcom CGMS receiver) is NOT waterproof.  The transmitter attached to his 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.


__________’s parents must be contacted for any of the following reasons: his pump infusion set comes out (insulin pump no longer connected to his body), his Dexcom site comes out, his pump alarms and cannot be remedied, his blood sugar is less than 60, his blood glucose exceeds 300, he has ketones in his blood, he becomes nauseated, or if he begins vomiting.

All school staff will be notified each year that __________has diabetes and will be instructed on what to do in the event of a hypoglycemic episode.

If a concern arises regarding __________’s health or academic progress, as affected by diabetes, there will be no hesitation to arrange a meeting among appropriate school personnel and parents.

His Teacher's sub folder will contain information regarding __________’s diabetes.

__________’s parents will provide a note in his backpack for daily communication with the school nurse, as needed. The note may include the carbohydrate amounts in ___________snack so the school nurse can calculate the appropriate amount to enter into __________’s pump. At least one of __________’s parents will always be available via telephone or e-mail.

__________parents will send all supplies for his insulin pump, blood glucose monitoring, and ketone monitoring. They will provide juice boxes, snacks, and Glucagon for treating hypoglycemia.

__________’s teachers will carry his diabetes supplies with them whenever they leave the classroom.  This bag will include the remote meter (for the pump) and all testing supplies.  This bag will travel with __________to and from school each day.

The nurse will notify __________’s parents when supplies are getting low.


It will be necessary for the teacher or school nurse to review and record the number on __________’s Dexie. If this number is lower than 100, his Blood Glucose must be checked by the nurse. A snack of 15-25 carbohydrates must be eaten prior to playing outside.

If __________’s pre-recess number is below 200, he MUST eat 10-15 carbohydrates prior to playing outside. __________’s parents will provide snacks.

If __________’s pre-recess number is above 200, he can play without a snack prior to playing outside.


 __________’s parents will provide juice boxes and snacks to be kept in the Health Office for treatment of hypoglycemia, class parties, and snack times. (use as needed)

__________will be permitted enough time to finish his snacks. __________’s teachers will need to view and record the number shown on __________’s Dexie on the small notebook provided in his Diego backpack. If this number is below 80, the school nurse should be notified. __________shall then be provided the snack with the rest of his class.

Once he has finished his snack, or is close to finishing his snack, the school nurse should be called to come to the classroom and administer his insulin via the insulin pump. All packaging for __________’s snack should be kept until the school nurse has had a chance to review the amount of carbohydrates in each item.

__________’s snacks should NOT be cleaned up and thrown away until the school nurse has confirmed the amount of carbohydrates eaten.  If he is resistant to finishing his snacks, the school nurse or a parent should be contacted for assistance. In most cases, __________will not have to finish his snack.

All school personnel will permit __________to eat a snack wherever he 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.  The teacher will notify __________’s parents as soon as she is aware of “extra” snacks.  He will need to receive insulin for the carbohydrates in the item(s) he eats/drinks prior to consumption (or possibly after, if it is uncertain he will finish the extra treat).  __________’s parents should be advised whenever unanticipated/extra insulin is given.

Whenever possible, class celebrations should be scheduled around __________’s routine care to allow for optimal blood glucose monitoring.    


Whenever __________comes to the nurse’s office his blood glucose must be tested, regardless of the reason for the visit.

At least two adults will be trained in blood glucose testing, pump operation, medication administration, and ketone testing. At least one trained adult will be available on school property or field trips to address __________’s medical needs at all times.  Parents are happy to provide necessary training as requested by school staff.  It is the school’s responsibility to ensure staff is prepared to accommodate __________’s needs.  In addition to recognition of a blood glucose problem and how to check __________’s blood sugar, training should also include administration of medication, which involves knowing how to perform insulin boluses using __________’s pump and knowing how to administer both insulin and Glucagon via injection in the event of a medical emergency.

When administering insulin, the current blood sugar and 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.  It can also be found on the final bolus delivery screen from both the insulin pump and the remote.  __________’s pump will calculate the recommended dose using the IOB information, regardless of whether or not the IOB was given for a correction or carbohydrate bolus.  

__________’s insulin pump should NEVER be disconnected for any reason without prior authorization from his parents.  __________’s insulin pump is waterproof.

__________’s insulin pump system includes a remote feature that should be used for all blood sugar checks and insulin administration.  The remote feature is NOT waterproof and should be protected from water at all times.  A back up meter will be kept in __________’s supply bag to be used in the event of a pump-meter malfunction ONLY.

__________requires assistance to understand what his glucose reading means.

__________will need to have his blood glucose levels checked every 2 -3 hours (or more often); including before snack, whenever an adult suspects a blood glucose problem, and whenever he alerts someone that he feels his blood glucose is too low or too high.  It may also be necessary to check his blood glucose level before, during and/or after physical activity, especially in situations of prolonged exertion.

Blood ketones should be tested whenever __________’s blood sugar is above 300.  If ketones are present, please contact parents.  (Blood ketones above 0.4)


__________may appear tired, HUNGRY, confused, “spacey“, whiny, uncooperative, combative, off balance/difficulty walking, or even say something like “I’m low” when his blood sugar is low.

If __________appears to have a low blood sugar, the nurse will be contacted IMMEDIATELY so that __________’s blood glucose can be tested and treated as quickly as possible.  If it is not possible to check __________’s blood glucose immediately, a juice box should be given under the assumption that his blood sugar is low.  His 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 his blood glucose and treat him whenever necessary. 

If the nurse is unable to come to __________, it is essential that an adult (not a student) accompany __________to the nurse for immediate medical attention when indicated.  

__________’s Dexcom is great at helping to catch lows before they get dangerous, however, once his blood sugar starts dropping fast, the Dexcom will take up to 30 minutes to be accurate again. Therefore, it will be necessary to have his blood sugar checked by finger poke to verify a low blood sugar, and again 10-15 minutes later.


__________may feel thirsty, sluggish, hungry, have a headache, blurred vision, and/or need to urinate often when his blood glucose is high.  When __________has a high blood sugar, he can sometimes have behavior issues towards other people.

Hyperglycemia (high blood sugar) should be monitored closely.  Whenever __________’s blood glucose is over 300 for more than 2 hours, the nurse should also check for ketones using the blood ketone strips.

If __________’s blood sugar is above 350, his parents must be notified immediately and blood ketones must be tested.

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.


__________shall be permitted to have access to water at all times.

__________shall be permitted to use the bathroom without restriction.

__________’s teacher will notify his parents if drinking or bathroom frequency seems excessive.


__________will be permitted to participate in all field trips and extracurricular activities without restriction.

The teachers will notify __________’s parents of field trip dates as early as possible.

Whenever possible, a parent (or grandparent) will accompany __________on class field trips specifically to attend to his medical needs. If a parent is unable accompany __________on a field trip, someone who is qualified to administer all diabetes related care will be provided by the school to accompany him.


__________’s behavior is often related to blood glucose levels. He can feel thirsty, sluggish, hungry and might have abdominal pain, a headache, blurred vision, or need to urinate often when his blood glucose is high.  He may appear tired, hungry, confused, “spacey”, whiny, uncooperative, combative, off balance/difficulty walking or say something like “I’m low” when it is low. 

If __________behaves in a manner that is out of character (i.e. disrespectful/ belligerent/defiant, hard time staying in his seat, sleepy, lethargic), his blood glucose must immediately be taken.

__________’s blood glucose level should fall within normal range (90 - 180) before disciplinary action is taken.  Additionally, he shall not be subject to disciplinary action for the first 60 minutes following a blood sugar problem, as it is possible that his recovery could take an extended amount of time.


__________will have access to the school nurse and his diabetes supplies whenever necessary.

Blood glucose levels should fall within normal range (90-180) for optimal learning and assessment of academic skills.  

__________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. A copy of this plan will be kept in __________’s classroom, in the nurses office, as well as __________’s file in the school office.

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