Diabetes Management Forms

The diagnosis of Diabetes can come in different forms, and the treatment plan for each individual person is unique. No matter what the treatment plan looks like, we want to work with you and your student to help them become as independent as they can when it comes to managing their diabetes.

Whether your student takes scheduled insulin, requires finger sticks, or is on a CGM or has a pump, we want to design a plan that enables them to take charge of their diabetes to the best of their abilities, and to do so in a safe environment.

Students can come to the Health Office for finger sticks if needed, or they may do them independently if they have shown that they can do so safely. In addition, if they are responsible for injecting their own insulin and are able to correctly calculate insulin requirements based on their carb intake, your student can be authorized to do so.

Our plan is to have your student be as independent as they can safely be with their diabetes care. Please see the following form. We will design a plan for each student. This form needs to be completed by the physician, as well as the parent(s)/guardian(s), the school nurse as well as the student. This form will accompany a 504/IEP/HCP from the prescribing physician/health care provider as well. Prior to the completion of the form, the student will meet with the school nurse to demonstrate their abilities and to go over the expectations and responsibilities of carrying their diabetic supplies with them.

Students need to understand that carrying their supplies/medication is a privilege, and that any demonstration of misuse of their medication and/or supplies will result in the student having to come to the health office for their diabetic care.