Student Diabetes Care Plan
Student Information
Student Name
Date of Birth
Grade/Class
Parent/Guardian Contact
Physician Name & Contact
Diabetes Information
Type of Diabetes
Type 1
Type 2
Other
Date of Diagnosis
Medication/Insulin Details
Daily Care Requirements
Blood Glucose Monitoring
Insulin Administration
Meals & Snacks Schedule
Emergency Care
Signs & Symptoms of Hypoglycemia
Treatment Procedure for Hypoglycemia
Signs & Symptoms of Hyperglycemia
Treatment Procedure for Hyperglycemia
Additional Information
Physical Activity Considerations
Special Instructions