My daughter has T1D and is beginning fourth grade at a Cy-Fair ISD (CFISD) school in Texas. CFISD district nursing staff have informed me that district policy prohibits school nurses in CFISD from remotely monitoring CGM data for their students. The rationale is that the school nurses don’t have time to do so. This is her fourth year at this school, and we are still struggling to have her medical needs met. She does have a 504 plan in place, but the school district refuses to consider remote CGM monitoring as an accommodation. Any advice?
Hi @Sakirk Sarah. Welcome to the forum. We are full of advice on living with T1D. I’ll start with a tip about the forum. Lots of parents have found the forum but are too busy parenting to check in very often. If you want to reach out to them use the search magnifying glass in the top right to search for 504, note the user names of parents in those discussions then reply to your post and include their username with the @ symbol in front of each one in the post. The forum will email them the post they are mentioned in.
Have you seen the American Diabetes Association’s sample 504 plan? http://main.diabetes.org/dorg/PDFs/Advocacy/Discrimination/504-plan.pdf I really like it because it provides definitions and a framework parents can add and remove items from.
The other thing I like about their plan is it defines the roles of the people who are supervising your child throughout the day. It is those people who need to know how to check your child’s blood sugar.
In your request to the school how did you define “remote monitoring”? What problems does it solve that the school’s proposed plan does not address?
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Hi @Sakirk welcome to Breakthrough T1D. Emergency medical plans can be directed by a doctor recommendation and by your input, but I have found that they are often a negotiation between you and the school director, however if you go to war a plan can be forced if you get a lawyer.
A possible negotiation could be that you remote monitor and will be given direct access (phone number, dedicated line) to get to the nurse staff directly in the event your child gets into an emergency and does not ask for help. I’m just thinking out loud whatever the security has to work for you. Good luck! 
When I was diagnosed in 1963 going to school with diabetes was - at least for me - much simpler than it is now: I took 1 shot of NPH insulin in the morning, ate a snack if needed (no 504 I’m place), and learned what an “insulin reaction” - aka low blood sugar - felt like. There was no way to test for it - that didn’t come until about the time I finished college - I just knew if I felt a certain way I needed a snack, even if was only 6 or 8 years old.
When she’s with you your daughter might be injecting or bolusing her own insulin, and administering amount needed.with. Schools may not allow kids to take a simple aspirin in their own so they won’t allow that; but on the other hand if your daughter needs a snack can her 504 plan allow her to take one after showing the nurse or other assigned person her reading rather than having them follow her? She or the nurse could keep a kit with the suggested items measured out and readily available for her to choose from when needed:
*If Laura’s number is less than or equal to ##, she may have any of the below *
One 7oz juice box
*## sandwich crackers *
*## Clif bloks
Lifesavers*
(Of course YLMV - your list may vary)
I do get the desire to add a follow feature to the 504 and the legality of doing so, but if I’m having an insane day and getting frequent alerts that would be lot for a school nurse to keep up with given that they may have hundreds of students to oversee.
What do you mean exactly by “remote CGM monitoring”? Do you want the nurses to check in on your daughter frequently to actively adjust her insulin/food like you would if she was at home or do you just want someone to remind her to eat a snack if she goes low?
Hi! Remote CGM monitoring refers to monitoring CGM data via an app that connects to the internet. In the case of Dexcom, CGM data is sent to the Dexcom Follow app. This app can be installed on a smartphone, and the user (in this case the school nurse) can view the CGM data and receive blood sugar alerts from within the clinic.
Sorry, I think I worded my question wrong. I know what remote monitoring is, dexcom follow is routinely used in my home.
My question is, what do you want the nurses to do with the information they would get from the app regarding your daughters blood sugars? How involved are you expecting them to be in her care? Do you want them to be tracking her and checking up on her several times a day or do you just want them to be aware if her blood sugar gets extremely high/low?
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