Section 504 Plan*
School: [name of school]
School Year: 2002-2003
Insulin Dependent (type 1) Diabetes
DOB: [date of birth]
[name] (Mom) Contact Number’s:
[child’s] Endocrinologist Numbers:
*The terms "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
The student has type 1 diabetes. Diabetes is a very serious disease for which there is no
cure. The student’s pancreas does not produce insulin, a hormone that is needed in
order for sugar to move from the blood stream to the cells, the process by which food
provides energy for the body. Therefore, someone with type 1 diabetes must take insulin
through shots each day or by wearing an insulin pump. However, insulin taken in this
manner does not cure diabetes and may cause the student’s blood sugar level to
become dangerously low. People with diabetes must carefully balance food, insulin
intake, and activity level to try to avoid dangerously high or dangerously low blood sugar
The most common immediate symptoms of high blood sugar levels (hyperglycemia) are
hunger, thirst, headache, blurry vision, frequent urination, nausea, drowsiness, and the
most serious possible short term consequence diabetic ketoacidosis, which can cause
breathing difficulties, dangerous electrolyte imbalance, coma, shock, and even death.
The long-term consequences of high blood sugar include eye and kidney disease, heart
attack, stroke, amputation of limbs, and a number of other serious health problems. The
only way to delay the complications of diabetes is through tight control of the blood sugar
Low blood sugar levels (hypoglycemia) create the most common immediate health risk
for students with diabetes. The most common symptoms of hypoglycemia include
tremors, palpitations and sweating, confusion, drowsiness, mood changes,
unresponsiveness, and unconsciousness. Hypoglycemia can result in seizures, brain
damage, or even death.
Accordingly, for the student to avoid the serious short and long term complications of
blood sugar levels that are either too high or too low, this Section 504 Plan, and the
accompanying Health Plan, must be carefully followed and strictly adhered to by
responsible school personnel.
OBJECTIVE/GOALS OF THIS PLAN
Both high blood sugar levels and low blood sugar levels affect the student’s ability to
learn as well as seriously endangering the student’s health. Blood glucose levels must
be maintained in the 90-180 range for optimal learning and testing of academic skills.
The student has a recognized disability, type 1 diabetes, that requires the
accommodations and modifications set out in this plan to ensure that the student has the
same opportunities and conditions for learning and academic testing as classmates, with
minimal disruption of the student’s regular school schedule and 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 and with the
student’s Health Care Plan, which is attached to this Section 504 Plan and incorporated
DEFINITIONS USED IN THIS PLAN
Authorized Diabetes Care Provider (ADCP): A school staff member who has received
training in the care of individuals with diabetes from a certified diabetes nurse educator,
a pediatric endocrinologist, or other diabetes medical specialist consistent with American
Diabetes Association (ADA) guidelines as set out in the ADA National Standards for
Diabetes Self-Management Education and that includes instruction in: the unassisted
administration of glucagon and insulin shots and recording of results; understanding
physician instructions concerning drug dosage, frequency, and manner of administration;
applicable state regulations concerning drug storage, security, and record-keeping;
symptoms of hypoglycemia and hyperglycemia and the time within which