Creating a Diabetes Medical Management Plan for School

If your child has diabetes, it is critical to set up a diabetes medical management plan (DMMP). This plan outlines the who, what, when, and where of your child’s diabetes care while at school. It takes into account daily diabetes management and food needs, includes special instructions for extracurricular and off-site activities, and covers what to do in an emergency.

School nurse checks child's blood sugar in office

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DMMPs are very detailed. You will create one in partnership with your child's healthcare team and the school's nurse and administration. It is personalized to your child and not only provides school staff with what they need to keep your child well, but parents and students peace of mind that everyone is on the same page. Simply knowing that the plan is in place can make kids tentative about being at school because of their diabetes more confident.

In this article, you'll learn the possible components of a DMMP and ways you are able to customize one for your child.

What to Include

The following sections are often included as part of a school DMMP. You may find that some of these don't apply to your child, and that's OK. You may also find that you need to share additional information that is not listed here, and that's OK too.

Each child with diabetes is different. And the great thing about a DMMP is that it can be customized.

If you'd like, you can review a sample DMMP form from the American Diabetes Association to get an idea of what the form you may receive might look like. The ADA also has a form specific for childcare settings.

Contact Information

This section lets the school know who to contact in case of an emergency. List the names of all parents/guardians, along with their addresses and phone numbers (mobile/work/home).

Also, be sure to include contact information for your child’s healthcare provider and any other emergency contacts, if desired.

School Staff

This section details who is on your child’s DMMP care team. This usually includes the principal, school nurse, and your child’s teacher. Other staff members that may be on the care team might include a school counselor and other trained diabetes personnel. 

Trained diabetes personnel are non-medical school staff members who will carry out diabetes management tasks when the school nurse is offsite or unavailable. They have received training in diabetes care, including performing blood glucose monitoring, insulin and glucagon administration, and ketone checks. They know how to recognize and treat hypoglycemia and hyperglycemia.

Indicate that the school administration, school nurse, trained diabetes personnel, and other staff will keep your child’s diabetes confidential unless your child decides to communicate about it with others openly.

Any substitute teachers will be provided with written instructions about your child’s diabetes management, along with a list of all school staff and trained diabetes personnel at the school. 

Basic Diabetes Care

This section outlines your child’s ability to self-manage their diabetes. Include which tasks they can perform on their own (if any) and what they need supervision with. List functions they need trained diabetes personnel to perform, such as checking blood glucose or administering insulin for them.

Also included in this section is information on the blood glucose meter your child uses:

  • Brand/model
  • Target range for blood glucose levels
  • When they need to check their blood glucose
  • Their preferred site of testing.

If your child has a continuous glucose monitor, also note what alarms are set and any thresholds for alarms to administer insulin.

Insulin Therapy

If your child takes insulin as part of their diabetes care, it’s important to detail:

  • Delivery type (syringe, pen, or pump)
  • Type of insulin used at school (adjustable, fixed, or none)
  • Your child’s typical insulin schedule
  • Dose calculations and a correction dose scale, if used

Provide authorization for if and when school staff identified in the DMMP are allowed to adjust your child's insulin dose and, if so, how much.

Treating Hypoglycemia

In this section, you should list specific symptoms your child usually exhibits when their blood sugar is too low (hypoglycemia). Be sure to note what reading qualifies as a low and what the appropriate treatment is.

This section should also state if your child keeps a "low box" at school and where it is located in case of a hypoglycemic event. This is a kit that contains supplies your child and staff will need to address low blood sugar, such as juice boxes, glucose tablets, and non-melting candy.

Treating Hyperglycemia

This section is similar to the above section, except that you should list your child’s usual symptoms when their blood sugar is too high (hyperglycemia). State what reading qualifies as a high and how to check for ketones.

Ketones are an alternative fuel the liver makes when it is burning fat for energy. In diabetes, this happens when insulin is too low. High ketones along with high blood sugar are a sign of diabetic ketoacidosis, a dangerous condition.

Provide instructions for how to treat hyperglycemia, including when and how much insulin to provide.

Meals and Snacks at School

Food affects blood glucose levels. Coordinating a meal and snack schedule with the school nurse and/or school nutrition team is important.

Include information about when your child will eat lunch and any snacks. It’s a good idea to state in the DMMP that they may need to eat earlier than scheduled (even in the classroom) if their blood glucose is low. 

In case of low blood glucose, indicate that a snack and quick-acting carbohydrate source must always be immediately available to your child. You may explain that you will supply snacks needed in addition to, or instead of, any snacks or treats supplied to all students. Also, state if you will include carbohydrate content information for any snacks brought from home.

Provide instructions on what should be done if food is provided in school, such as during a birthday celebration.

Classroom Work

People with diabetes often require more doctor’s appointments than someone without diabetes. It’s important to state in your child’s DMMP that they cannot be penalized for absences required for medical appointments and/or illness.

Your child should be allowed to make up any missed classwork without being disciplined. If required by school policy, you, as parent or guardian, will provide documentation from the treating physician for your child’s absence.

A child with diabetes may need further accommodations during regular classes or exams, such as going to the nurse's office. They will be allowed to make up any missed assignments. Your child may be given extra time to complete a test or take the test at another time without penalty.

Physical Activity

Just as any other student, your child should be allowed to fully participate in physical activity and team sports while at school, unless otherwise noted in the DMMP.

Include that all physical education instructors and sports coaches must have a copy of the emergency action plan. They also must be able to recognize and assist with the treatment of low blood glucose levels.

Make sure to state that a blood glucose meter, a quick-acting source of glucose, and water must be readily available on-site where physical education classes, team sports practices, and games are held.

If needed, note how many carbs should be consumed for longer durations of activity, as well as if/when your child should avoid physical activity altogether.

Bathroom and Water Access

School staff should allow your child to use the bathroom when needed.

State in the DMMP that your child must have access to water. This includes being allowed to keep a water bottle at their desk and with them at all times, and allowing them to use the drinking fountain when needed.

Bus Transportation

If your child takes the bus to school, it's important to include a section regarding bus transportation.

Include in the DMMP that any bus driver who transports your child must be aware of the symptoms of high and low blood glucose levels, as well as how to treat both.

The bus driver should also receive this information in writing for quick reference.

Field Trips and Extracurricular Activities

Outline in your child’s DMMP that they are allowed to fully participate in all school-sponsored field trips and extracurricular activities. These include sports, clubs, and enrichment programs. They will need to have all of the accommodations and modifications outlined, including necessary supervision by school personnel identified in the DMMP.

You, as parent or guardian, should not be required to accompany your child on field trips or any other school activity in order for them to participate.

Additionally, a school nurse or trained diabetes personnel should be available and on-site at all school-sponsored field trips and extracurricular activities that your child attends.

Depending on the length of the activity, all usual aspects of diabetes care should be maintained. This includes, but is not limited to blood glucose monitoring, responding to any hypoglycemia and hyperglycemia events, providing snacks and access to water and the bathroom, and administering insulin and glucagon (if needed). 

The school nurse or another staff member will make sure that your child’s diabetes supplies accompany them on any school-sponsored travel. 

Emergencies and Disasters

In the case of an extended emergency or disaster at the school, it’s a good idea to provide a 72-hour emergency kit for your child to keep there.

Indicate where this is kept at the school. During any emergency, your child’s DMMP will continue to be followed.

As part of the emergency kit provided by you, there should be additional instructions for evening and nighttime diabetes care (just in case).

When to Notify Parents/Guardians

There is always the chance that something can go wrong while your child is at school. Provide a list of situations that warrant immediate notification to you.

This might include:

  • Low blood glucose readings even after treatment for hypoglycemia
  • Symptoms of severe hypoglycemia
  • Symptoms of severe hyperglycemia or presence of ketones
  • Insulin pump malfunctions
  • Any injury
  • Your child refusing to eat or take their insulin as outlined/scheduled

Summary

A diabetes medical management plan for school is developed jointly by parents/guardians and school staff. It outlines how your child will receive diabetes care at school and details information ranging from when they should eat to what medication is given when to what to do in an emergency and more.

These plans are meant to be customized. Answer the questions that apply to your child, and add in any details you feel are needed.

A Word From Verywell

While it may seem like there are a lot of details to include in a diabetes medical management plan for your child, know that it will help make sure things run smoothly and safely for your child while at school.

After you have prepared and submitted your child’s DMMP to the school, make sure to update it every year, or sooner if your child’s diabetes treatment plan has changed.

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  1. Westerberg DP. Diabetic ketoacidosis: Evaluation and treatment. Am Fam Physician. 2013;87(5):337-346.