Samantha has Type 1 (Juvenile Diabetes). Diabetes is a serious, chronic metabolic disease that In Type I Diabetes, the pancreas does NOT make any insulin. …
Section 504 Plan
Name: DOB: Grade: 4
School: Rosendale Elementary School School Year: 2002-2003
Background
Samantha has Type 1 Juvenile Diabetes Diabetes is a serious,
chronic metabolic disease that impairs the bodys ability to use food
Insulin, a hormone produced by the pancreas, helps convert the glucose in
food into energy In Type I Diabetes, the pancreas does NOT make any
insulin Without insulin, glucose cannot be used by the body as fuel
Over many years, high blood glucose levels can cause damage to; eyes,
kidneys, nerves, heart and blood vessels Without sufficient glucose
levels to the brain, it may lead to unconsciousness, coma, seizures and be
life-threatening if not treated properly
People with Type 1 Diabetes do NOT produce insulin and must receive
insulin through either injection or an insulin pump Insulin taken in this
manner does NOT cure Diabetes and may cause Samanthas blood glucose level
to become dangerously low, if food and insulin requirements arent kept in
balance All people with Diabetes must carefully balance, food,
medications, and activity level to keep blood glucose levels
as close to
normal as possible
Type 1 Diabetes places Samantha at risk for hypoglycemia low blood
glucose and hyperglycemia high blood glucose episodes related to
metabolic dysfunction Potential fluctuations in blood glucose impact
Samanthas major life activities in the area of learning, which is one of
the major life activities described in Section 504
Both high blood glucose levels and low blood glucose levels will
affect Samanthas ability to learn and perform in school, as well as
seriously endangering her health Blood glucose levels must be maintained
in the 80-180 range for optimal learning and testing of academic skills
Type 1 Diabetes requires some accommodations and modifications set out in
this plan This will ensure that Samantha has the opportunity and
conditions for learning and academic testing with minimal disruption of her
regular school schedule, with minimal time away from the classroom Steps
to prevent hypoglycemia and hyperglycemia, and to treat these conditions if
they occur must be taken in accordance with this plan
Definitions
Hypoglycemia - Low blood glucose is the most immediate health problem for
students with Diabetes It occurs when the
body gets too much insulin, too
little food, a delayed meal, or more than usual amount of exercise
Symptoms of mild to moderate hypoglycemia include, shaky, tremors,
sweating, lightheadedness, irritability, confusion, erratic response to
questions, stomach ache and drowsiness A student with this degree of
hypoglycemia will need to promptly ingest a carbohydrate snack/juice and
may require assistance Severe hypoglycemia may lead to unconsciousness and
seizures and can be life threatening if not treated promptly
Hyperglycemia - High blood glucose occurs when the body gets too little
insulin, too much food or too little exercise It may also be caused by
stress or an illness such as a cold The most common symptoms of
hyperglycemia are thirst, frequent urination and blurry vision If left
untreated over time, hyperglycemia can cause a serious condition called
diabetic ketoacidosis DKA characterized by nausea, vomiting and high
level of ketones in the urine For Samantha who wears an insulin pump,
lack of insulin supply may lead to DKA in several hours DKA can be life
threatening and thus, requires immediate medical attention
Insulin Pump - An insulin pump is a way to deliver
insulin Through the
insulin pump the individual receives insulin around the clock via a small
needle or plastic tube, which is inserted in her abdomen, buttocks or
thigh Children and their parents are taught how to program the pump to
deliver insulin, as they need it This means the individual will need to
program the pump before each meal to give a determined insulin dose
Glucagon - A hormone that is produced by the body It stimulates the liver
to raise the blood glucose level Glucagon is available in an injectable
form It is administered to treat severe hypoglycemia low blood glucose
levels when an individual is unable to eat or drink Nausea and vomiting
are common side effects after a person is given Glucagon
Accommodations Necessary for Samantha
1 The school nurse and/or parent will inform each staff member about
Samanthas condition There will be a meeting conducted before or
during the first week of school
2 A knowledgeable designated person, and back up person will be
available during the entire school day and for extra-curricular
activities offered by the school district to ensure proper blood
glucose testing and designated
responsibility to administer a Glucagon
injection in an emergency
3 Each staff member will be given a Diabetes folder detailing
Samanthas condition This folder will contain Samanthas care plan at
school, contact information and an explanation of Diabetes
4 All school support staff, including secretaries, cafeteria staff and
bus drivers will be made aware that she has Type 1 Diabetes and be
able to identify her Explanation of emergency instructions/care
should be given to these individuals
5 If necessary, a Diabetes Educator will visit the school and conduct a
meeting with all staff to further train or give further information to
the staff in Diabetes care and emergency instructions
6 All staff and personnel will be educated in meeting the needs of
Samantha and recognize the signs of hypoglycemia low blood glucose
and hyperglycemia high blood glucose
7 Each Classroom including the gymnasium Samantha is in, will be
equipped with an area for juice boxes, drinks and other appropriate
snacks for the treatment of hypoglycemia low blood glucose
8 Medical supplies will be kept in the Nurses Office It
is the parents
responsibility to make sure that the supplies are sufficient quantity
and not expired This may include; blood glucose monitor, test strips,
glucagon injection kit, lancing device, lancets, ketone strips,
insulin, insulin pump supplies, extra batteries, instant glucose and
any other equipment/food/drink as deemed necessary
9 It is the parents responsibility to notify the Nurse/School of
Medical Treatment changes The parents must educate the Nurse on any
new treatments, supplies or situations
10 It is the parents responsibility to alert Nurse/School if Samantha has
been experiencing atypical blood glucose results at home
11 All Medical Waste must be disposed of according to the rules set in
motion by the Niskayuna Central School District, as well as State of
New York
12 Samantha will be permitted to carry glucose snacks, juices, blood
glucose meter and various other supplies deemed necessary related to
her Diabetes care in a backpack or on her person
13 Samantha shall be permitted to have immediate access to water,
including keeping a water bottle in her possession and being
allowed
to use the drinking fountain without restriction
14 Samantha shall be permitted to use the bathroom without restriction
15 Samantha shall be permitted to have snacks in the classroom and on the
bus
16 Samantha shall be permitted to leave class at any time to go to the
nurses office or Main Office for Diabetes related issues
17 Samantha will have access to the school nurse when ever necessary
18 When Samantha or a staff member believes she is having signs of high
or low blood glucose levels, a blood glucose level should be checked
If Samantha request or needs to go to the Nurse, she should NEVER be
sent alone Due to the possibility of hypoglycemia episode could
deteriorate and coma or seizures may go undetected in the hallway
Another student or staff member shall accompany her to the Nurse
19 While Samantha is achieving independence in self-management of her
Diabetes, the adults who work with her will need to be supportive and
understanding about her daily regimen and integrate them into the
school day
20 Samantha will be allowed to test at any time any where on school
grounds including but
not limited to; classroom, cafeteria, field
trips, extracurricular activities or on the school bus If her
results are outside of the predetermined target range, she must notify
the Nurse Samantha may need assistance or phone her parents, nurse
or doctor for the treatment of hypoglycemia or hyperglycemia
Samanthas plan of care should be followed regarding treatment of
blood glucose readings and or signs and symptoms of high or low blood
glucose readings
21 For Physical Education/Gym class, Samantha will be given adequate time
to test blood glucose levels and have a snack, without consequences
22 Samantha will be permitted, if necessary, to check blood glucose
levels before or during ANY class, test, or standardized tests, to
ensure appropriate blood glucose levels levels outside the target
range above 200 or below 80 may affect cognitive abilities and
attention levels If her blood glucose levels are NOT within target
range she will be able to treat her blood glucose levels per her plan
of care Additional time will be allowed for her to take her test to
accommodate testing/adjustment
issues related to her Diabetes or she
will be able to take a test at a later time or date without
consequences
23 When Samantha is stressed and/or excited as in a testing situation,
her blood glucose levels become erratic She may have a high or low
blood glucose level that may require treatment including; juice/snack
to maintain normal blood glucose level, become thirstier requiring
more water and the need to urinate more frequently Additional time
for her to complete a test may be needed
24 If Samantha is unconscious and unable to eat, drink or swallow, she
will need an injection of Glucagon Specific instructions about the
administration of Glucagon, an emergency treatment of severely low
blood glucose, can be found in the Nurses office as well as in each
Staff members folder If Glucagon is administered, immediately dial
911 and contact the parents One additional staff member shall be
trained in the administration of Glucagon
25 An appropriately trained individual will accompany Samantha on all
field trips and extracurricular activities outside the schools
premises if a parent cannot
attend The individual will provide all
usual aspects of diabetes care including, but not limited to; blood
glucose testing, insulin pump management, treatment of hyperglycemia
and hypoglycemia, providing snacks, access to water and bathroom,
administration of Glucagon or insulin if needed
26 Information on Samanthas Diabetes will be included in all Substitute
teachers plans These teachers must be aware that she has Diabetes
The substitute must be aware of her rights bathroom, drinking,
snacking in class, going to the nurse etc
27 An attempt will be made to have a substitute nurse when the nurse is
absent If one cannot be located, the parents will be notified
28 Samantha will be permitted to participate in extracurricular
activities The coach/leader/instructor will be made aware of her
diabetes He/She will be able to identify an emergency situation and
be familiar with the appropriate action to take
29 There will be no penalty by the school district for any diabetes
related absences or tardiness including medical appointments There
shall be an established procedure for getting the daily work to
Samantha if she is out because of her Diabetes
30 Teachers will inform Samantha of any assignments missed while in the
nurses office She will be given a reasonable amount of time to
complete any such assignment without consequences
31 Bus drivers on both the pick up and drop off routes including any
school approved events or trips must be informed about Diabetes and
permit snacks or juices on the bus to be consumed
32 Keep Samanthas Diabetes confidential, except to the extent that she
decides to openly communicate about it with others
33 Diabetes is a learning experience Both Samantha and her family work
very hard to control her blood glucose levels Sometimes despite
everyones best efforts the blood glucose levels are out of range
When blood glucose levels are out of range, it is important that
everyone take a calm non-judgmental approach to taking steps to bring
the blood glucose levels into the target range
34 It is important that even though people around Samantha may be
frustrated, or blame the highs or lows on something or someone,
realize that these feelings may be projected to the child and
make her
feel badly about herself
35 New devices and procedures are always being introduced This plan will
be reviewed and changed as necessary
36 Family contact numbers; Home 372-8735, Mothers cell phone 423-2844,
Fathers cell phone 368-3277, pager 341-3732, Work/FD 374-8386,
Grandparents 346-2767, cell s 669-5124/669-5894, Aunt Sue Home 374-
9441, Work 381-1121
37 Other Contact numbers; Dr Linda Riddick Pediatric Endocrinologist @
AMCH 262-5723 Kathi Davis/Kristine Wohlfahrt - Nurse Diabetic
Educators AMCH 262-5996 Mini-Med Insulin Pump Tech Support 800-826-
2099 Number is also listed on the back of the insulin pump
38 References; NYSDOH School Resource Guide, Children with Diabetes
website - wwwchildrenwithdiabetescom Juvenile Diabetes Research
Foundation - wwwjdrforg, 518-477-CURE American Diabetes
Association
wwwdiabetesorg
Comments:___________________________________________________________________
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Signatures of Agreement:
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Parent Date
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Principal Date
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Nurse Date
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Teacher Date
Source:navy.mil
