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Life with diabetes can bring a lot of stress, but one of the most stressful events for parents and children with diabetes can be the return to school.
With the COVID-19 pandemic still raging across the country, differing mask mandates per state, the division of in-person versus remote learning, and our youngest still not able to be vaccinated, questions for back-to-school are looming large in everyone’s mind.
Here’s the most important information you need to know to go back to school with confidence:
Know your rights
Section 504 of the 1973 Rehabilitation Act was the landmark first civil rights law specifically related to disability rights enacted in the United States.
The law prohibits discrimination against people with disabilities, including diabetes, in all programs that receive federal financial assistance, and this includes all public schools.
This was the precursor to the 1990 Americans with Disabilities Act that further protects people in the school and work environments.
Under these federal laws, children with diabetes are protected to fully participate in both their diabetes management and education while at school. Some of these protections include:
- Schools to provide a trained staff member to test blood sugar levels and administer both insulin and glucagon to the student when/if needed
- Schools to provide a trained staff member to provide diabetes care during extracurricular events, sporting events, and field trips (and any other school-sponsored activities)
- If able, students are permitted to self-manage their diabetes (treat lows and/or take insulin) anytime, anywhere
Some states have taken protections a step further, enacting what are known as “Safe at School” laws.
These state laws enforce federal law and offer further protections for children. See if your state has enacted a Safe at School law here.
Develop a 504 plan
In addition to protections under the law, students with disabilities are encouraged to develop what is known as a “504” plan (named after the section of the Rehabilitation Act that protects people’s rights!) that goes into greater detail about their needs as a person with diabetes in the school setting.
A sample 504 plan may include things like:
- Permitting a student access to food, beverage, and water whenever necessary
- Allowing for additional absences for doctor’s visits, blood work, etc.
- Allowing extra time for tests and assignments if the student experiences a high or low blood sugar
- Allowing unlimited bathroom visits
- Noting all emergency contact numbers, including those of their endocrinologist
- Permitting access to all diabetes technology at all times (CGM, insulin pump, glucometer, etc.)
- What to do in case of an emergency (fire drill, lock down, early dismissal, etc.)
Sample 504 plans can be found here.
Develop a Diabetes Medical Management Plan (DMMP)
Working with your endocrinologist, you should also include a diabetes medical management plan (DMMP) in your 504 document.
This provides more specific guidance detailing how to manage the student’s diabetes, and should be given to all teachers, coaches, and staff that will interact with your child, including the school nurse.
Helpful guidance in a DMMP includes:
- How to operate all CGMs, insulin pumps, glucometers, and other diabetes technology
- Insulin to carbohydrate ratios
- Correction factors
- How often blood sugar is checked
- How to manage blood sugars during gym class, sporting events, and during other kinds of physical activity
- Symptoms of both high and low blood sugars
- At what number (mg/dL) to treat a low blood sugar
- At what number (mg/dL) to treat a high blood sugar
- Guidance on how many carbohydrates are needed to treat a low blood sugar
- At what number (mg/dL) to test for ketones
- What to do when ketones are present
- When to call for emergency medical services
- When to call the parents
A sample DMMP can be found here.
Equipping yourself with a DMMP and a 504 plan can help protect your child’s rights and ensure that they’re getting the very best diabetes care while at school.
Make a plan
During your next visit to the endocrinologist, develop your initial DMMP and bring it with you when you meet with your child’s school nurse (ideally before the school year starts).
Additionally, you will need to contact the school’s principal or guidance counselor to set up a 504 planning meeting, where you will discuss your child’s needs with both the administration and the school nurse, coming up with a school plan that will work for everyone.
Back to school during COVID-19
Going back to school during COVID-19 can be a fraught experience but following these guidelines can help equip you to make the best decision possible for your child and family.
In-person, remote, or hybrid?
More and more schools are offering hybrid schedules for the 2021-2022 school year. Since children are both lower risk but also unable to be vaccinated at the time of this writing (only children ages 12 and up are currently being vaccinated), parents of children with diabetes may want to opt for a hybrid model of learning, or fully remote learning, if time and resources can make that possible.
However, the social isolation of remote learning can be unhealthy for some kids, so families need to determine what will work best for them and their situation.
Check mask mandates
Recently, the American Academy of Pediatrics came out with their recommendation that all students in schools this fall should wear masks at all times, regardless of vaccination status. AAP cannot mandate anything, they can only give recommendations.
At the same time, some Governors across the country have signed laws banning mask mandates in public places, most notably schools.
Check the status of your state to make an informed decision about your plan for back-to-school-time for you and your family.
There is no one right answer
Much like diabetes, everyone’s experience, trauma, fear, and plan of attack for back-to-school will look different during COVID-19.
With the Delta variant bringing yet another wave across the country, there will be no single right answer for people and their children.
But staying informed on the latest viral numbers in your area, taking precautions around mask wearing, choosing a format of learning that will work for you, studying up on your state’s laws around diabetes management in schools, and preparing both a DMMP and a 504 plan will go a long way to preparing you for the school year ahead!
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A Parent’s Guide for Back-to-School with T1D
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