Diabetes school action plan

Guardian contact details

What insulin is your child currently taking?








Does your child have coeliac disease?

Does your child do their own BGL testing?

If no, who is the teacher that will be assisting with checking BGL?

Does your child need?



What type of fast acting (Sugar serve hypo treatment) hypo food does your child have at school?




Please specify 'other' type

Please specify quantity of each Sugar serve hypo treatment

What type of long acting (Sustaining carb) hypo food does your child have at school?




Please specify 'other' type

Please specify quantity of each Sustaining carb

What carbohydrates does your child use before sport and activity at school?




Please specify 'other' type

Please specify quantity of each carbohydrate for sport and activites

Does child keep any extra diabetes supplies at school?






Does the child need?:



What device does your child use to administer the insulin at school?





Child requires:





What type of pump is your child using?




Please specify type

Does child keep spare pump supplies at school?




Is your child able to:










Please select the device they are currently using