Kindergarten with Type 1 Diabetes

Preparing for Kindergarten with Type 1 Diabetes

Preparing for Kindergarten with Type 1 Diabetes can be daunting. Not for the kid but for the parent! Remember, your child will assume that everything will be ok. It’s the parents that need a little reassurance!

Through our T1D school advocacy group, we recently hosted a “Preparing for Kindergarten with T1D” event. A member from our school district administration’s Student Health Services spoke and shared some tips for a smooth transition.

Here is is a recap of some of those tips with a few of our own!

Safety is a priority

Safety is a priority for all students but especially for Type 1 Diabetics. The laws for school nurses are actually written with the safety of the student in mind.

The Diabetes Medical Treatment Plan

On or before the first day of school, you will need to meet with the school nurse or clinic to establish your child's Diabetes Medical Management Plan (DMTP).  Your school may also call it an Individualized Health Plan. No matter the name, this document will outline the procedure for treating your T1 student in the school setting.

This will be the most important thing you put in place for your child at school.
It is NOT a 504 Plan – the DMMP outlines medical treatment at school.

Schedule an appointment with the school nurse

At Kindergarten registration, you should meet your nurse and explain you have a Type 1 Diabetic student. Ask when she would prefer to get together before school starts in the Fall.  It varies for each nurse and campus. At the end of summer, just before school starts, this nurse/cinic meeting is when you will need to bring your student’s doctor’s orders and extra supplies.

Remember, nurses may only start the week before school starts. They may also be completing their own Back to School training. Setting an appointment will ensure you have the nurse’s complete attention for the paperwork.

Back to School Packet – Health Care Provider Orders

Your child’s endocrinologist will provide you with detailed written orders called Health Care Provider Orders.  These are for the school nurse to include in the DMMP. These orders are valid for one year at school. Most families receive them over the summer.

Review the Doctor’s Orders. Parents are NOT allowed to override these orders.You can however update them with your doctor.

  • Verify that they are correct.
  • Include all medical devices including cell phones
  • Make sure it notes the max distance share devices can be from the child.
  • For CGMs, it should also designate alarm parameters.
  • Include the use of Wi-Fi if needed.
  • Review the list of items on these orders that you need to provide the school.

Note: The school will not be providing low blood sugar snacks or Ketone strips.

The 504 Plan comes later

You do NOT need a 504 Plan on the very first day of school for a Kindergarten student. You do need the Diabetes Medical Treatment Plan. They are two different things.

Did the school say “No” to a 504 Plan?

It will help if you understand the following about 504 Plans:

It is a more complex and longer process because it involves more school staff. The Individual with Disabilities Education Act actually requires school districts to do an  evaluation process to determine if a child may need other learning accommodations at the same time. It will involve the nurse, 504 Coordinator and the teacher and there is lots of paperwork involved even for you!


Did they mean “Not Now?”

“No” may just mean “Not now”. Back to School time is CRAZY for all school staff. A 504 Plan should be purposeful and individualized. It requires HOMEWORK.

The evaluation, paperwork, process and meetings all take time. Be patient. Many families do not even implement their 504 Plans until 2nd grade in preparation for standardized testing.

So breathe – the 504 comes later.

Your student will still be covered for all their medical care with the
Health Plan/DMTP you put in place with the school nurse/clinic


Start stocking up!

Start stocking up on extra supplies – Glucagon, meters, test strips, insulin, Ketone strips, back up insulin pens/needles, infusion sets, batteries etc. Make sure your endocrinologist knows you need EXTRA supplies for school so they can write prescriptions accordingly.

Spring stocking! Start in the Spring so that you have the extra supplies you need by Fall. Plus it spreads out the cost over a longer period of time.

You may find a sheet like this in your
Health Care Provider Orders/Back to School Packet.


Create supply boxes

In addition to medical supplies, you will need low blood sugar treats/juices. All of this can go in one box for the clinic.
Provide your students supplies in a container with the name on it. A refillable water bottle will also come in handy.

You will want to create some extra classroom snack boxes too for Lockdown Emergencies. You can ask your nurse for the school plan on Lock Downs when you create your child's Diabetes Medical Treatment Plan. 

Bus transportation

If you plan for your Kindergarten student to ride the bus, notify the nurse in advance. For extra precaution, you should also notify transportation services. The school district will provide a handout and  training to the bus driver regarding the student’s condition. It is important to communicate with your school district if your T1D Kindergarten student will ride the bus.

 School lunches

For school lunches you should plan to provide the carbs on each item when you prepare the lunch. The school nurse can’t be expected to determine carbohydrates on items prepared and brought from home. Labeling each item individually allows adjustments to be made with picky eaters. The nurse will make insulin doses based on the day’s lunch.

Buying lunches at school is also an option. To ensure proper dosing, plan to print the weekly lunch menu and obtain the carbs from the school website. You can involve your child in the process of deciding what they want to eat. By involving the child in the process, the student is more likely to eat the foods chosen.

Lunchtime is the busiest time for school nurses. These little tips will help with a smooth transition especially that first week of school.

 Important reminders

Since doctor’s orders will be written for your child, nurses are NOT legally allowed to deviate from those orders.
They are also NOT allowed to make changes to treatment based on a parent’s instructions. That’s a legal and a safety issue for our school nurses. If you understand that, it will eliminate some of the frustration that may occur.

If the doctor’s orders provided are not working, request changes to your doctor and resubmit them to the nurse. It is not unusual to make changes such as these. In fact, that will likely happen many times over the course of your student’s school career with Type 1 Diabetes.

Communication and collaboration

As the parent of a Type 1 Diabetic, you will have a great deal of communication with the school clinic. This will be an important relationship for your family. Try to start on the right foot by asking what you can do to help on your end.

A positive collaboration with your school nurse will make for a positive environment for your Type 1 Diabetic student.

Written by Anne Imber
published on 4/13/2017

Anne Imber is the mom to a Type 1 Diabetic son diagnosed in 2009. As the Founder of Type 1 To Go Teen, Anne shares her experiences with other Type 1 families regarding many of the non-medical issues that Type 1 Diabetic Teens face. The website provides support materials from her presentations. Anne is also the Co-Founder of Cy Fair Type One Connection, a T1 School Advocacy & Support Group for one of the largest school districts in Texas.

This information provided for general use only.
It is not intended as medical and/or legal advice.
Always consult your doctor for medical advice.
All Rights Reserved. 

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