Individual Diabetes Management Plan 2014-2015
These detailed plans are completed by the parents/guardian and school personnel specifically for the student. Information outlines trained school personnel, contact information, blood glucose testing, insulin administration, student self-management abilities, food, physical activity and supplies.
Insulin Administration Order
This form is completed by parents/guardian to notify schools of insulin dose instructions. The completed form can be faxed to the Diabetes Center for co-signing. Use fax number (614) 722-3062.
Diabetes Care at School
Provides an overview of diabetes for non-medical personnel.
Hypoglycemia (Low Blood Glucose) Emergency Plan
A step-by-step plan to recognize and treat an individual with low blood glucose.
Hyperglycemia (High Blood Glucose) Emergency Plan
A step-by-step plan to recognize and treat an individual with high blood glucose.
Glucagon Emergency Plan
This guide provides instructions to administer glucagon to an individual experiencing a severe low blood glucose.
Calculation Sheet for Rapid-Acting Insulin Bolus
This form helps to calculate the insulin dose given to an individual prior to eating.
Diabetes Monitoring Log for the School Year 2014-2015
Use this form to record and monitor blood glucose testing, ketone testing, insulin dosages, vial/cartridge changes and comments.
Diabetes ID Sheets
This quick medical reference is ideal for individuals who are not intensively trained in diabetes management.
Diabetes SOS Forms: Sick Day Self-Management
This flow sheet is designed to assist caregivers when managing a patient’s diabetes while sick. Also includes the Ketone Correction Bolus Worksheet.
Diabetes Blood Glucose/Insulin Record
Log sheet for caregivers to record blood sugars and insulin doses. Form can be faxed to our office for help with insulin dose adjustments.
Insulin Pump Glucose Log
This log sheet allows caregivers to record blood sugars and insulin doses, which can be faxed to our office for assistance with pump settings and insulin dose adjustments.