 school.
EQUAL TREATMENT AND ENCOURAGEMENT
1. Encouragement is essential. The student must not be treated in a way that
discourages the student from eating snacks on time, or from progressing in doing
his/her own blood glucose tests and general diabetes management.
2. The student shall be provided with privacy for blood glucose testing and insulin
administration if the student desires.
ADCPs, DCAPs, BDDCPs, and other staff will keep the student’s diabetes confidential,
except to the extent that the student decides to openly communicate about it with others.
NOTIFY PARENTS/GUARDIANS IMMEDIATELY IN THE FOLLOWING SITUATIONS:
* Symptoms of severe low blood sugar such as continuous crying, extreme tiredness, or
loss of consciousness.
*The student’s blood glucose test results are below 70 or are below 80, 15 minutes after
consuming juice or glucose tablets.
*Symptoms of severe high blood sugar such as frequent urination, presence of ketones
or blood glucose level above 400.
*The student refuses to eat or take insulin injection.
*Other: Any reason you feel you need to contact Mom (Cell: [phone]).
EMERGENCY CONTACT INSTRUCTIONS
1. Call the student’s mother at work. If unable to reach parent/guardian:
2. Call the student’s parent/guardian’s cell or work phone. If unable to reach
3. Call [name] at [number]
4. Call [name] at [location]
Other emergency contacts:
[name, address, phone]
This Plan shall be reviewed and amended at the beginning of each school year or more
often if necessary.
Physician Signature & Date
School Representative and Title Date