The 504 Plan sets out an agreement to make sure the student with diabetes has the same access to education as other children. It is a tool used to make sure that the student, the parents/guardians, and school personnel understand their responsibilities and work through challenges or misunderstandings to avoid problems in the future.
The summer is coming to a close, and the first day of school is nearing. The back-to-school checklist for children with diabetes includes much more than crayons, glue sticks, and a new backpack.
If your child with diabetes is starting school this year, have you started thinking about your 504 Plan? If you have one in place, have you looked at it to see if you need to make any changes?
Lucky for us, there was already a child with diabetes at our school, and the family shared their 504 plan with us. It was a great starting point. We didn’t actually have our plan finalized until the second semester of kindergarten, but we ended up adding a couple of things that we wouldn’t have thought of before school started.
We’ve reviewed it each year and made updates as needed.
What is a 504 Plan?
From the ADA website:
The 504 Plan sets out an agreement to make sure the student with diabetes has the same access to education as other children. It is a tool that can be used to make sure that the student, the parents/guardians, and school personnel understand their responsibilities and work through challenges or misunderstandings to avoid problems in the future.
The term “504 Plan” refers to a plan developed to meet the requirements of a federal law that prohibits discrimination against people with disabilities, Section 504 of the Rehabilitation Act of 1973 (commonly referred to as “Section 504”).
Section 504 applies to all public schools and to private schools that receive federal funds. The same plan would also be appropriate under another law that protects students with disabilities, the Americans with Disabilities Act (ADA). The ADA covers all public schools and all private schools except those run by religious institutions. (If the religious institution receives federal funds it is also covered.)
504 Plan Considerations
Trained Diabetic Personnel: School will identify Trained Diabetes Personnel (TDP) who 1) Know how to test blood sugar levels and interpret the results. 2) Know how to measure and administer insulin given by a syringe or insulin pump. 3) Know how to respond to hypoglycemic events, including the use of the Glucagon kit.
Training: Training for TDP will be provided by a diabetes educator, nurse, or parents.
Location for Pre-Lunch Testing: School will provide an appropriate location for daily pre-lunch blood sugar testing and lunchtime insulin by injection or pump.
Access to Bathroom and Water: Child will be allowed unrestricted access to the bathroom, water fountain/or water bottle, snack, and the office when they are not feeling well. The child can carry water and extra glucose sources.
Insulin Delivery: A TDP or nurse will supervise daily glucose monitoring and administer insulin via injection or insulin pump. If a substitute is not aware of how to administer insulin, the school will call the parents.
Testing: Glycemic conditions can affect the child’s testing. Therefore: 1) Blood sugar should be tested before important tests. 2) Child needs to eat their regularly scheduled snacks even if they are during a test. 3) If a diabetes-related activity (testing blood, snack, water, bathroom) must occur during a timed test, the child will be given the equivalent extension of time at the end of the test.
Recognition of Hypoglycemic Conditions: All staff in charge of the child’s class should have training or in-service on recognizing hypoglycemic conditions.
Fieldtrips: A TDP will accompany the child on any trips away from school when a parent cannot attend.
Parental Notifications: Parents will be notified when food supplies need to be replenished, when the child has abnormal readings, has pump problems, when the schedule is significantly changed, or when the nurse is absent. Notification should occur as soon as possible.
Substitute Teacher: Substitute teachers will be notified of the child’s diabetes and made aware of which staff members are TDP. Substitutes should be notified in the lesson plan that they are to use the TDP when needed.
Lunch Time: Child can go to the front of the lunch line to get lunch and/or milk so that they have time to get their food started before insulin is administered.
Hallway Transportation When Hypo or Hyperglycemic /Not Feeling Well: Child should be accompanied by an adult or responsible student when going to the office if they are not feeling well.
Emergency Supplies: Child’s emergency supplies and insulin pump bag (or meter/syringes/insulin) will be listed on the student roster to ensure they accompany child during fire drills, field trips, and any time they leave the immediate school grounds.
Lock Down Situations: Child will have a blood sugar meter and snacks in an additional location accessible during a lockdown.
Ketones: Child should use their blood ketone meter (or urine ketone strips) anytime their blood sugar is over 300.
Of course, how your family manages your child’s diabetes based on your care team’s recommendations will dictate specific wording and instructions. But training staff, having access to water and snacks, making sure that your child’s supplies go with them when they leave the school grounds, making accommodations for testing, and ensuring the child has enough time to eat their lunch are important points to consider. We didn’t think about lockdown situations until another school in the district was on lockdown. Now we will have extra supplies in another location.
If your school has a full-time nurse in residence, you may have less need for more trained personnel. But the reality is that many schools have only a part-time nurse if they have one at all.
Some of these items may not seem important to your younger child (like timed testing, which doesn’t occur in our state until third grade). However, it is easier to add items when you first set up the 504 plan rather than add them later. (But note that a 504 plan is a fluid document, and you should be able to make changes at any time.)
If you have a change in care routine, such as changing from MDI to a pump, it is important to modify your 504.
And it is my understanding that if your school receives a dime of federal funding, they are required to allow you to have a 504 plan in place.
Is your 504 plan in place and updated for the coming school year?
Back to School with Diabetes: Lots of information and links!
I have an entire chapter about school in my book Kids First, Diabetes Second.
Read more posts about Diabetes at School.
Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.
(Originally published August 9, 2010. Updated May 29, 2021.)