Section 504 Plan for NJH XXXX Early Childhood School, Plano ISD 2011-2012 Type 1 Diabetes, as diagnosed

by a physician, is a physiological disorder that affects the endocrine system. Type 1 Diabetes places the individual at risk for hypoglycemic and hyperglycemic episodes related to metabolic dysfunction. Potential fluctuations in blood glucose impact the individuals major life activities in the area of learning, which is one of the specific major life activities described in Section 504. This is a condition in which the pancreas is unable to make insulin. Without insulin, the body cannot convert glucose (sugar) into the energy a person needs. To compensate for the lack of natural insulin, Nate wears an insulin pump (OmniPod). We use his insulin pump to administer the correct doses of insulin to match the carbohydrates in the food he eats (bolus) and the amount his body needs without food (basal rates). Nates basal rates and boluses must be balanced with his meals, snacks, health, stress level, and physical activity. To consistently achieve this balance, he must check his blood glucose frequently. Nate will need to have his blood glucose levels checked every 2 -3 hours; including before snack, before recess, whenever an adult suspects a blood glucose problem, and whenever he alerts someone that he feels his blood glucose is too low or too high. It may also be necessary to check his blood glucose level before, during and/or after physical activity, especially in situations of prolonged exertion. Nates target blood sugar range throughout the school day is 90 - 180. While Nate is achieving independence in self-management of his diabetes, the adults who work with him will need to be supportive and understanding about the daily regimen. At this time, he is unable to perform his diabetes care independently. His self-care needs will be integrated into the school day in an attempt to provide minimal interruptions of the learning environment.

COMMUNICATION AND SUPPLIES:

Nates parents must be contacted immediately for any of the following reasons: o o
o

o o
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Nates pod alarms or comes off Blood sugar is less than 60 Blood glucose exceeds 250 He has ketones Becomes nauseated, or if he begins vomiting He is injured (not a minor injury)

All school staff that provides care for Nate will be notified each year that Nate has diabetes and will be instructed on what to do in the event of a hypoglycemic episode. If a concern arises regarding Nates health or academic progress, as affected by diabetes, there will be no hesitation to arrange a meeting among appropriate school personnel and parents.

Teacher's sub folder will contain information regarding Nates diabetes. Nates parents will provide a note in his backpack for daily communication with the school nurse. The note will include the carbohydrate amounts in Nates snack so the school nurse can calculate the appropriate amount to enter into Nates pump. At least one of Nates parents will always be available via telephone or e-mail. Nates parents will send all supplies for his insulin pump, blood glucose monitoring, and ketone monitoring. They will provide juice boxes, snacks, and Glucagon for treating hypoglycemia. Nates testing supplies and fast acting carbohydrates will be in the in the same room (or on the playground) with Nate at all times. Nates pump will be readily available to administer insulin when needed and maintained in a safe place. These same supplies will be taken on field trips, fire alarms/drills, emergency evacuations and lockdowns. This bag will include the remote meter and all testing supplies. This bag will travel with Nate to and from school each day. The nurse will notify Nates parents when supplies are getting low.

SNACKS AND MEALS:

Nates parents will provide juice boxes and snacks to be kept in the Health Office and classroom for treatment of hypoglycemia Nate will be permitted enough time to finish his snacks and meals. He will require 10 minutes before his scheduled snack time to go to the nurse for glucose monitoring and insulin administration. After his insulin is administered, he will need to begin eating as soon as possible to prevent hypoglycemia. He will require a minimum of 20 minutes to finish his entire snack. It is IMPERATIVE that Nate finishes his entire snack. Nates snacks should NOT be cleaned up and thrown away until a school staff member confirms that Nate has eaten everything. If he is resistant to finishing his snacks, the school nurse or a parent should be contacted for assistance. All school personnel will permit Nate to eat a snack wherever he is (including, but not limited to: classrooms, gym, auditorium, school grounds, field trips, and school bus) whenever necessary to treat, prevent, or follow a hypoglycemic episode. Nate should not be excluded from class celebrations, including birthday and holiday parties. He will need to receive insulin for the carbohydrates in the item(s) he eats/drinks prior to consumption. Nates parents should be advised whenever unanticipated/extra insulin is given. Whenever possible, class celebrations should be scheduled around Nates routine care to allow for optimal blood glucose monitoring.

GLUCOSE AND KETONE MONITORING:

Whenever Nate comes to the nurses office for an injury or illness that may impact his blood glucose level his blood glucose must be tested. At least two adults will be trained in blood glucose testing, pump operation, medication administration, and ketone testing. At least one trained adult will be available on school property or field trips to address Nates medical needs at all times. Parents are happy to provide necessary training as requested by school staff. It is the schools responsibility to ensure staff is prepared to accommodate Nates needs. In addition to recognition of a blood glucose problem and how to check Nates blood sugar, training should also include administration of medication, which involves knowing how to perform insulin boluses using Nates pump and knowing how to administer both insulin and Glucagon via injection in the event of a medical emergency. When administering insulin, the current blood sugar and amount of Insulin On Board (IOB) should always be taken into consideration. This information can also be found on the final bolus delivery screen from pumps remote. Nates pump will calculate the recommended dose using the IOB information, blood glucose level and carbohydrate bolus. Nates insulin pump should NEVER be taken off for any reason without prior authorization from his parents unless requiring Glucagon. Nates insulin pump (the pod) is waterproof. Nates insulin pump system includes a remote feature called a Personal Diabetes Manager (PDM) that should be used for all blood sugar checks and insulin administration. The PDM is NOT waterproof and should be protected from water at all times. A back up meter will be kept in Nates supply bag to be used in the event of a PDM malfunction ONLY. Nate will need to have his blood glucose levels checked before snack, recess, or whenever an adult suspects a blood glucose problem, and whenever he alerts someone that he feels his blood glucose is too low or too high. It may also be necessary to check his blood glucose level before, during and after physical activity, especially in situations of prolonged exertion. Ketones should be tested whenever Nates blood sugar is above 250. If ketones are present, please contact parents

LOW BLOOD SUGAR (HYPOGLYCEMIA):

Nate may appear tired, hungry, confused, spacey, whiney, uncooperative, combative, off balance/difficulty walking, or even say something like Im low when his blood sugar is low. If Nate appears to have a low blood sugar his blood sugar will need to be checked immediately. Nates blood glucose can be tested and treated as quickly as possible. If it is not possible to check Nates blood glucose immediately, a juice box should be given under the

assumption that his blood sugar is low. His blood glucose must be checked 10 - 15 minutes later to verify that it is over 80. If it is over 250, please contact parents for further instructions.

When low blood sugar is suspected, Nate must not be left alone. In the event of suspected low blood sugar, with obvious warning signs, it is preferred that a trained staff member come to Nate to check hi blood glucose and treat him whenever necessary. If the nurse is unable to come to Nate, it is essential that and adult (not a student) accompany Nate to the nurse for immediate medical attention when indicated. Nate will not be left alone at any time including the hallways, particularly when a low blood sugar is suspected.

HIGH BLOOD SUGAR (HYPERGLYCEMIA):

Nate may feel thirsty, sluggish, hungry, have a headache, blurred vision, and/or need to urinate often when his blood glucose is high. Hyperglycemia (high blood sugar) should be monitored closely. Whenever Nates blood glucose is over 250, the nurse should also check for ketones using the blood ketone meter. Lack of insulin supply, which can occur with a pump malfunction or an occlusion in the canulla, may lead to diabetic ketoacidosis (DKA) within a few hours. Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated promptly.

WATER AND BATHROOM ACCESS:

Nate shall be permitted to have access to water at all times. Nate shall be permitted to use the bathroom without restriction. Nates teacher will notify his parents if drinking or bathroom frequency seems excessive.

DISCIPLINARY ACTION:

Nates behavior is often related to blood glucose levels. He can feel thirsty, sluggish, hungry and might have abdominal pain, a headache, blurred vision, or need to urinate often when his blood glucose is high. He may appear tired, hungry, confused, spacey, whiney, uncooperative, combative, off balance/difficulty walking or say something like Im low when it is low. If Nate behaves in a manner that is out of character (i.e. disrespectful/ belligerent/defiant, hard time staying in his seat, sleepy, lethargic), his blood glucose must immediately be taken. Nates blood glucose level should fall within normal range (90 - 180) before disciplinary action is taken. Additionally, he shall not be subject to disciplinary action for the first 60 minutes following a blood sugar problem, as it is possible that his recovery could take an extended amount of time.

Both high blood sugar levels and low blood sugar levels affect Nates ability to learn and perform, as well as seriously endangering his health. Blood glucose levels must be maintained in the 90-180 range for optimal learning and testing of academic skills. Nate has a recognized disability, Type 1 Diabetes, that requires the accommodations and modifications set out in this plan to ensure that he has the same opportunities and conditions for learning and academic testing as classmates, with minimal disruption of his regular school schedule and with minimal time away from the classroom. Steps to prevent hypoglycemia and hyperglycemia and to treat these conditions should they occur must be taken in accordance with this Plan and with the Medical Information Form to follow (Diabetes Health Care Plan). This form will be provided by Nates parents and given to the school nurse, along with medication orders to be kept on file in the nurses office. Furthermore, training should be provided to all adults who provide education/care to Nate, which would include awareness of symptoms and treatment of hypoglycemia and hyperglycemia and other emergency procedures. An adult and back-up adult(s) should be trained to 1) perform blood glucose monitoring and record the results; 2) take appropriate actions for blood glucose levels outside of the target ranges as indicated in Nates Diabetes Health Care Plan; 3) test the blood for ketones when necessary, and respond to the results of this test; 4) Be trained in the administration of insulin and glucagon, if required, as outlined in the Plan; and 5) an adult and back-up adult responsible for Nate who will know the schedule of his snacks and work with his parents to coordinate this schedule with that of the other students as closely as possible. This individual also will notify his parents in advance of any expected changes in the school schedule that affect Nates meal times or exercise routines. Nates parents will be happy to assist in the education on Type 1 Diabetes, which will include, but is not limited to, instructional videos and literature.

Parents Signature: School Nurse Signature: School Principal Signature:

______________________________________Date:_____________ ______________________________________Date:_____________ ______________________________________Date:_____________

Amendment
to

Section 504 Plan for Nathan Houston Beaty Early Childhood School, Plano ISD 2011-2012

1. The Agreement is amended as follows: Under the sections titled: HIGH BLOOD SUGAR AND HYPERGLYDEMIA and GLUCOSE AND KETONE MONITORING it is only necessary to check for blood ketones if Nates blood glucose level is over 350. 2. Except as set forth in this Amendment, the Agreement is unaffected and shall continue in full force and effect in accordance with its terms. If there is conflict between this amendment and the Agreement or any earlier amendment, the terms of this amendment will prevail.

Parents Signature: School Nurse Signature: School Principal Signature:

______________________________________Date:_____________ ______________________________________Date:_____________ ______________________________________Date:_____________