Pamela D. Wilson, MS, BS/BA, NCG, CSA
Although you've managed countless highs and lows while raising your child with diabetes, sending them to school might still be a little unsettling. You're definitely not alone in feeling this way!
Fortunately, creating a 504 plan for your child with type 1 diabetes (t1d) can help you feel secure knowing that school personnel is trained and available to help if an unexpected health situation occurs. A 504 plan ensures that diabetes supplies, snacks, and other accommodations make it easy for your child to enjoy learning and excel in extracurricular activities.
Here's an overview of 504 plans, as well as how to develop a plan and work with school administrators to help your child get the support they need.
How a 504 plan supports students with T1D
504 plans are born from Section 504 of the Rehabilitation Act of 1973, which ensures students with diabetes, other health conditions, and disabilities receive reasonable accommodations in K-12 public schools, private schools, and colleges that receive federal funding. Your 504 plan will outline how to best support your child's diabetes care while they're in school. You'll collaborate with school administrators, teachers, the school nurse, and other staff who will provide input and approve the plan.
For example, perhaps your child will need assistance taking blood sugar readings, administering insulin, and recognizing signs of high or low blood sugar. Combined with a Diabetes Medical Management Plan (DMMP), the 504 plan provides medical background, tools, and additional resources that school staff need to help a child manage t1d. This concept is similar to an Individualized Education Plan (IEP), which is a collaboration between school personnel and parents that outlines how to best support children with special education needs.
Create your 504 plan as a family
As a family, you may be concerned about your child getting special treatment in school. Your child may also be concerned about standing out by having privileges that other children don't — like carrying snacks and eating lunch at a designated time. But remember that the goal of a 504 plan is to ensure your child can excel and stay healthy at school.
To prepare for your 504 plan meeting with school administrators, start by familiarizing yourself with these plans. The American Diabetes Association offers a model 504 plan that you can review. The plan should be tailored to your child's needs and may include the following actionable steps:
- Identify the school staff who will be trained to provide diabetes management support.
- Describe the child's diabetes supplies and equipment and what healthcare tasks they may need assistance with.
- Outline a schedule for blood glucose monitoring and insulin.
- Provide guidance on the child's snacks and meals.
- Discuss participation in physical education classes, team sports, field trips, and other activities.
- Ensure the child's access to water and bathrooms as needed.
- Support confidentiality as requested by the student or family.
- Review guidelines for rescheduling coursework or tests due to diabetes care needs.
- List emergency contacts and state when parents should be contacted.
The key to success is creating a plan three to four months in advance of the school year or as soon you know about your child's t1d diagnosis. This lead time allows everyone to learn and feel comfortable with the plan.
Build an education plan with school personnel
Since you're an expert in managing your child's diabetes, you're the best person to educate school staff. The plan you create may include hands-on demonstrations, teaching materials about t1d from your doctor or other sources, and methods for ongoing communication. You may need to:
- Help faculty and staff understand t1d and answer common questions.
- List the daily components of managing diabetes.
- Identify signs of high or low blood sugar.
- Explain how to check blood glucose levels.
- Describe the different types of insulin or how a continuous glucose monitor (CGM) works.
- Create a tip sheet for adjusting insulin doses if applicable.
- Demonstrate how to use glucose tablets or a diabetic emergency kit.
- Discuss the effects of exercise, stress, and illness on insulin levels.
Consider creating an agenda for your meeting with school administration, and think back to your learning curve. How did you feel when you first discovered that your child had diabetes? How did you gain confidence and work through the uncertainty you experienced about "getting it right"? Keep this in mind as you educate staff.
During your 504 plan meeting, consider demonstrating how to check your child's blood glucose and administer insulin. You might even bring extra supplies so that the staff can practice using a glucometer and test strips. Agree upon a designated area in the school where you can store additional supplies — in addition to the supplies that your child will have on hand at all times. Also, establish the best way for staff to contact you or another family member with questions throughout the school day, whether through text, a phone call, or email.
At the end of the meeting, express appreciation for the staff's time commitment. You might also confirm your family's commitment to participate and make the plan a success.
Request a DMMP from your child's endocrinologist
In addition to the 504 plan, you'll also need to provide your child's school with a Diabetes Medical Management Plan, which offers specific medical information. Ask your child's endocrinologist to help prepare this document, which outlines:
- Times of day to check blood glucose.
- How to use a CGM.
- Symptoms of hypoglycemia and hyperglycemia, including how to resolve these concerns.
- Details about insulin therapy and carbohydrate ratios.
- Authorization to adjust insulin.
- Your child's ability to manage their diabetes care and where they might need assistance.
- A plan for physical activity and sports, including snacks, the use of glucose tablets, and administering insulin.
- A disaster or emergency plan.
The 504 and medical management plans should be kept in several locations at the school so that all authorized personnel can easily access them. If your child attends a private or religious school that doesn't receive federal funding, creating a 504 plan may require additional planning and flexibility. Ask your physician to write a letter of support to the school, and offer additional training for anyone who might be uncomfortable providing diabetes care.
A 504 plan for your child with type 1 diabetes is most successful when working as a team with school staff, ensuring ongoing communication, and identifying changes or additional needs. By committing to the plan's success, you can pave the way to support the success of other families who may have similar needs.
Hoping to find more information about helping your child manage diabetes? Explore the Health Insights library of articles covering a variety of useful topics.