This page outlines the key components of effective school-based diabetes management and provides practical tips and resources to help schools and primary care providers improve care for students with diabetes.
- Good blood glucose control is critical for long-term health as well as for optimal academic outcomes—fluctuations in blood glucose levels can affect attention and information processing.
- Students with diabetes have been found to miss more school, but adjustment to the disease and effective communication with the school increase attendance.
- Training other school staff is a significant responsibility, and surveys have shown that school nurses lack confidence in this area. Studies have found that most teachers know little about the disease, and parents and students have reported challenges with teachers’ understanding.
Best Practice and Clinical Guidelines for School-Based Diabetes Management
- Diabetes Care in the School Setting, American Diabetes Association
Position statement with recommendations for diabetes management in the school setting
- Safe at School, American Diabetes Association
Includes training modules on diabetes care tasks, posters, diabetes medical management plan and emergency care plans, and tips for teachers and school nurses - Colorado Kids with Diabetes, Colorado Kids with Diabetes Care and Prevention Collaborative
Includes standards and guidelines, a school nurse toolkit section, training for staff, and resources for providers, families, and teachers - School Nursing Evidence-Based Clinical Practice Guideline: Students with Type 1 Diabetes Toolkit
(Will need to create a free account to access the toolkit)
Toolkit designed to help school nurses implement evidence-based recommendations for improving the health and safety of school-aged children with T1D.
Policy Statement
School-based health centers can be an excellent resource for diagnosis, education, treatment, and care coordination. See the American Academy of Pediatrics’ policy statement on this topic for more information about coordination between school-based health centers, primary care, and school health services.
Key components of diabetes management in schools
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- Identify students with diabetes through a review of health history and/or medication forms, and collect additional needed information
- Nurse Files, Colorado Kids with Diabetes
Includes intake forms, checklists, and provider order forms - Management of Diabetes in Schools, Maryland State Departments of Education and Health
Includes guidance on gathering medical information
- Nurse Files, Colorado Kids with Diabetes
- Flag students with diabetes within the health section of the school’s records or identify another method to easily track students with diabetes (e.g., spreadsheet, registry)
- Notify teachers and other appropriate personnel of students with diabetes and provide training to recognize and respond to diabetes emergencies (for resources, see education/training section)
- Record and monitor key data for students with diabetes, such as completion of needed forms, medication administration, absenteeism, and hyper/hypoglycemic episodes
- Assess students’ level of control and need for more intensive case management based on rescue medication use, blood glucose levels, attendance, hospitalizations/ED visits, etc.
- When storing records and communicating regarding student health conditions, follow confidentiality guidelines
- HIPAA and FERPA, National Association of School Nurses
NASN resources on HIPAA and FERPA, including a webinar and 2 radio broadcasts - Data Privacy in School Nursing: Part 1 and Part 2, The Network for Public Health Law
Overview of HIPAA and FERPA with FAQs from school nurses - Data Sharing Guidance for School Nurses, The Network for Public Health Law
Overview of laws with questions and examples for setting up data sharing agreements - Joint Guidance on the Application of the Family Educational Rights and Privacy Act and the Health Insurance Portability and Accountability Act of 1996 to Student Health Records, US Dept. of Health and Human Services and US Dept. of Education
Guidance with FAQs to clarify implementation of HIPAA and FERPA in relation to school health services
- HIPAA and FERPA, National Association of School Nurses
How primary care providers can help
- Explain to families the importance of informing the school about the child’s diabetes, turning in all school health forms, and providing the school with medications
- Maintain blank paper and electronic copies of school district health forms for families to complete
- Assist families that may need help with completing health forms and fax them directly to the school nurse/school health office
- Ask families to sign a consent form to allow communication with the school
- Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
Consent form for schools and providers to share information
- Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
- Write insulin orders as a range of doses with explanation of the decision process for a change in dosage. Nurses can only legally take medical orders from prescribing providers, not parents, so medication orders should not be written as “Parent may adjust insulin doses for school nurse”
- Notify the school health office of patients whose diabetes is not well-managed or who require special monitoring
- Identify students with diabetes through a review of health history and/or medication forms, and collect additional needed information
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Steps for schools
- Ensure that students with diabetes have a current Diabetes Medical Management Plan (DMMP) on file
- Diabetes Medical Management Plan, American Diabetes Association
Sample management plan - Sample Diabetes Medical Management Plan, Connecticut State Department of Education
Sample management plan - State Policy Database, National Association of State Boards of Education (NASBE)
Lists states with legal requirements related to diabetes plans
- Diabetes Medical Management Plan, American Diabetes Association
- As needed, develop an Individualized Healthcare Plan (IHP) for students with diabetes. Partner with families and providers to set goals for diabetes management. The school may also need to develop a 504 plan or IEP to ensure equal educational access
- Section 504 Plan, American Diabetes Association
Sample 504 plan for students with diabetes - Nurse Files, Colorado Kids with Diabetes
Includes IHP guidance - Management of Diabetes in Schools, Maryland State Departments of Education and Health
Includes guidance on IHPs - Guidelines for Care of Students with Diabetes, Washington State Department of Health
Includes information on 504 plans - Diabetes, Wisconsin Department of Public Instruction
Offers templates for IHPs and 504 plans
- Section 504 Plan, American Diabetes Association
- When developing DMMPs, IHPs, and/or 504s/IEPs, consider diabetes management during school-sponsored activities, field trips, before- and after-school care, and times when a school nurse is not present
- Field Trips: Guidance for School Nurses, Connecticut State Department of Education
Information on considerations related to field trips for students with special health care needs
- Field Trips: Guidance for School Nurses, Connecticut State Department of Education
- Periodically evaluate students’ plans to ensure they contain current information (eg, medications, contact information) and that their needs are being met
How primary care providers can help
- Provide patients with diabetes with a DMMP for use at school. If possible, send the plan directly to the school nurse/school health office in addition to giving a copy to the family
- Include your office contact information on the DMMP
- Respond promptly to questions from the school regarding the DMMP and provide requested information for the development of an IHP or other management plan
- Keep in mind that not all schools have a school nurse present at all times. Ensure that the DMMP and any other orders are written in a way that can be understood by trained school staff
- Ensure that students with diabetes have a current Diabetes Medical Management Plan (DMMP) on file
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Steps for schools
- Maintain written emergency protocols with clear communication procedures and responsibilities
- Nurse Files, Colorado Kids with Diabetes
Includes hyper- and hypoglycemia flow sheets - Management of Diabetes in Schools, Maryland State Departments of Education and Health
Includes guidance on emergency management - Guidelines for Care of Students with Diabetes, Washington State Department of Health
Includes information on responding to emergencies
- Nurse Files, Colorado Kids with Diabetes
- Train all staff on how to recognize and respond to a diabetes emergency (see educate/train staff)
- Assure immediate access to prescribed medications, including during field trips and school-sponsored activities (see manage medications)
- Plan for access to medications, food, and supplies during lockdowns, evacuations, and other disaster procedures
- Consider maintaining stock glucagon if allowed within your state
How primary care providers can help
- Assist patients with obtaining emergency medications to store at school
- Volunteer to review school emergency protocols
- Assist schools in training staff on recognizing and responding to diabetes emergencies
- Secure caregiver permission to communicate with the school to facilitate communication during urgent situations
- Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
Consent form for schools and providers to share information
- Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
- Work with the state or local school health services program lead to provide standing orders and other assistance to schools in maintaining stock glucagon (if allowed and needed within your state)
- Advocate for stock glucagon in schools if not allowed within your state
- Maintain written emergency protocols with clear communication procedures and responsibilities
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Steps for schools
- Develop and maintain written policies and protocols for diabetes management within your district. Policies and protocols provide guidance for staff and communicate expectations for all stakeholders
- Model Policy on the Management of Diabetes in Schools, Michigan State Board of Education
Sample policy on diabetes management for school districts - Accommodating Students with Diabetes, Washington Office of Superintendent of Public Instruction
Sample policy on diabetes management for school districts
- Model Policy on the Management of Diabetes in Schools, Michigan State Board of Education
- Ensure that policies and protocols adhere to national and state laws and regulations, including state nurse practice acts
- State Laws, American Diabetes Association
Information on state laws related to school-based management of diabetes - State Policy Database, NASBE
Lists states with legal requirements related to diabetes plans
- State Laws, American Diabetes Association
- Policies and protocols should address:
- Routine and emergency management
- Medication administration and nursing delegation or administrative assignment, including provisions for self-carry and self-administration, standing orders, and stock medications
- Procedures for field trips, the bus, and before- and after-school activities
- Documentation
- Procedures for errors
- Use of written care plans
- Maintenance of a safe environment
How primary care providers can help
- Educate school leadership about the importance of written policies and protocols
- Volunteer to help develop or review district policies and procedures to ensure that they are comprehensive, aligned with best practice, and practical given available staffing and resources (see resources above)
- Develop and maintain written policies and protocols for diabetes management within your district. Policies and protocols provide guidance for staff and communicate expectations for all stakeholders
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Steps for schools
- Support self-carry of testing supplies and medications, including glucagon, for students who have demonstrated competence in self-care
- Nurse Files, Colorado Kids with Diabetes
Includes independent management agreement - Guidelines for Blood Glucose Self-monitoring in Connecticut Schools, Connecticut State Department of Education
Recommended components for policies on self-monitoring of blood glucose levels
- Nurse Files, Colorado Kids with Diabetes
- Work with families, providers, and insurers to obtain medication and supplies for school use
- Ensure that medications and supplies are stored in secure yet easily accessible locations during the school day, during school-sponsored activities, and during field trips
- Guidelines for Provision of Health Services on Field Trips or Extracurricular Activities, Colorado Dept. of Education
Guidelines for health services during school-sponsored trips and activities
- Guidelines for Provision of Health Services on Field Trips or Extracurricular Activities, Colorado Dept. of Education
- Maintain documentation of medications stored, authorizations, all care tasks provided, and medication errors
- Nurse Files, Colorado Kids with Diabetes
Includes care logs - Management of Diabetes in Schools, Maryland State Departments of Education and Health
Includes guidance on monitoring and medication management - Sample Policies and Forms, Mass.gov
Sample medication orders, authorizations, logs, and policies - Guidelines for Care of Students with Diabetes, Washington State Department of Health
Includes information on blood glucose monitoring
- Nurse Files, Colorado Kids with Diabetes
How primary care providers can help
- Assess patient readiness to self-administer and provide recommendation to the school
- Provide ongoing self-management education to patients
- Respond to questions from the school regarding medications
- Assist families in securing medication and supplies to keep at school
- Support self-carry of testing supplies and medications, including glucagon, for students who have demonstrated competence in self-care
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Steps for schools
Staff
- Define staff roles. Diabetes training should be provided at 3 levels:
- Basic information about diabetes and how to identify and respond to emergencies for all staff
- Student-specific training for teachers and staff assigned to a student with diabetes
- Comprehensive training for school nurses and/or, where provided by law, Unlicensed Diabetes Care Attendants, on diabetes care as prescribed in student DMMPs or physician orders (e.g., insulin and glucagon administration, ketone checks, etc.)
- In larger districts, consider having a diabetes resource nurse who receives additional specialized training and has time allotted to answer questions and provide support to other nurses
- Provide regular training and assessment on relevant skills and information, keeping in mind the prior knowledge and health literacy level of the audience
- Diabetes Care Tasks at School, American Diabetes Association
Curriculum that can be used to train non-medical school personnel to perform diabetes care tasks - Training and Delegation, Colorado Kids with Diabetes
Multiple training and assessment resources - Management of Diabetes in Schools, Maryland State Departments of Education and Health
Includes guidance on staff training - Medication Administration in Missouri Schools: Guidelines for Training School Personnel, Missouri Department of Health and Senior Services
Detailed guidance on training staff to administer medications - Care Coordination for Students with Diabetes, National Association of School Nurses
E-learning on providing evidence-based care for students with diabetes in school - Chronic Health Conditions Toolkit for Non-Medical Staff in Schools, Tennessee Department of Education
Provides an overview of diabetes and how to respond to emergencies for non-medical school staff - Medication Training, Wisconsin Department of Public Instruction
Training videos, tests, and skills check-off on glucagon and insulin administration
- Diabetes Care Tasks at School, American Diabetes Association
Students
- Provide coaching and education when interacting with students in order to support increased independence in self-management
- Consider offering formal self-management education for students with diabetes
Families
- Consider offering diabetes education programs for families
- Provide written information to support diabetes management at home
How primary care providers can help
- Volunteer to assist with developing, reviewing, or delivering trainings to school nurses and staff, particularly on newer technologies and devices (see resources above)
- Recommend or provide patient education materials
- Communicate with school nurse about children and families that may need additional education, such as newly diagnosed or poorly controlled patients
- Advocate for adequate numbers of licensed school nurses in schools
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Steps for schools
- Assist families without a primary care provider and/or insurance with accessing health care
- Does Your Child Have Health Insurance? AASA
Toolkit to assist schools in identifying uninsured children and connecting them to coverage - Health Insurance for Children: How Schools Can Help, Centers for Disease Control and Prevention (CDC)
Guidance for schools on connecting students with health insurance
- Does Your Child Have Health Insurance? AASA
- Obtain consent from caregivers to communicate with students’ primary care providers about diabetes (consider including in annual consent form)
- Sample HIPPA/FERPA Release Forms, Arkansas.gov
Consent forms for schools and providers to share information - Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
Consent form for schools and providers to share information - Guidelines for Care of Students with Diabetes, Washington State Department of Health
Includes information-sharing release form
- Sample HIPPA/FERPA Release Forms, Arkansas.gov
- Communicate with students’ providers and/or caregivers regarding challenges with blood glucose control, frequent absences, or other concerns
- Notify caregivers (and primary care provider, if appropriate) of hyper- and hypoglycemic events at school
- Identify local resources that can support students with diabetes
- Parents for Healthy Schools, CDC
Collection of resources, including guidebook, presentation, e-learning module, and idea sheets for engaging parents in school health, including chronic condition management - Partner Build Grow, The Center for Health and Health Care in Schools
Action guide for sustaining school-based approaches to support cognitive, social, emotional, and physical health - Nine Elements of Effective School-Community Partnerships to Address Student Mental Health, Physical Health, and Overall Wellness, Coalition for Community Schools
White paper on ways school-community partnerships can create positive health and academic outcomes - Management of Diabetes in Schools, Maryland State Departments of Education and Health
Includes guidance on care coordination - Local Health Department and School Partnerships: Working Together to Build Healthier Schools, National Association of Chronic Disease Directors
Report with case studies and strategies for successful partnerships between health departments and schools - Opportunities for School and Hospital Partnership in the Management of Chronic Conditions, National Association of Chronic Disease Directors
Report with strategies for successful partnerships between hospitals and schools - Partnership Building to Support Students Managing Chronic Health Conditions, National Association of School Nurses
Webinar on how to create, strengthen, and sustain partnerships to support students with chronic health conditions to be safe, healthy and ready to learn - Addressing Diabetes Factors in Elementary School Children through School and Community Partnerships, National Nurse-Led Care Consortium and School-Based Health Alliance
Guidebook that highlights how health centers can partner with schools to address Type 2 diabetes risk factors
- Parents for Healthy Schools, CDC
- Consider partnering with a local hospital, American Diabetes Association Chapter, the Juvenile Diabetes Research Foundation, public health department, nursing school, or community provider to provide education to staff, families, and/or students
How primary care providers can help
- Obtain consent from caregivers to communicate with the school
- Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
Consent form for schools and providers to share information
- Sample HIPAA-Compliant Authorization for Exchange of Information, Connecticut State Department of Education
- Recommend community resources and partners that can support students with diabetes
- Consider serving as a consultant to the school district or participating on a school health or wellness committee
- Elicit feedback from the school nurse, who typically has access to daily blood glucose readings and knowledge of the patient’s self-management skills
- Assist families without a primary care provider and/or insurance with accessing health care
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Steps for schools
- Ensure adequate school nurse staffing
- Role of the School Nurse in Providing School Health Services, American Academy of Pediatrics
Policy statement outlining the importance of a school nurse in every school - School Nurse Workload: Staffing for Safe Care, National Association of School Nurses
Position statement on appropriate school nurse staffing
- Role of the School Nurse in Providing School Health Services, American Academy of Pediatrics
- Assure students have quick access to needed medications and supplies (see manage medications)
- Implement needed accommodations as outlined in IEP and 504 plans
- Ensure that nutritional information is provided for all school lunches
- As appropriate to their knowledge and skill level, allow students to perform management tasks in the classroom and provide a private location that can be used as an alternative
- Create a positive social climate that fosters acceptance, inclusion, and full participation for all students
How primary care providers can help
- Work with families and schools to support full participation by students with diabetes
- Advocate for adequate school nurse staffing
- Ensure adequate school nurse staffing
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Steps for schools
- For students with poor control, consider having school nurses provide case management or additional services such as home visits, assisting with making appointments, connecting with transportation assistance, etc.
- Translating Strategies into Actions to Improve Care Coordination for Students with Chronic Health Conditions, National Association of School Nurses
White paper that proposes a common definition of care coordination and identifies actions for implementing effective chronic condition management in schools
- Translating Strategies into Actions to Improve Care Coordination for Students with Chronic Health Conditions, National Association of School Nurses
- Provide additional support and training opportunities to equip school nurses to identify issues relating to poorly controlled diabetes and develop solutions
How primary care providers can help
- In districts with adequate health services staffing, partner with school nurses, counselors, social workers, and school-based health centers to support case management and care coordination through the school and suggest services and supports that would be helpful to the student and family
- For students with poor control, consider having school nurses provide case management or additional services such as home visits, assisting with making appointments, connecting with transportation assistance, etc.
Last Updated
03/18/2021
Source
American Academy of Pediatrics