2022-2023 Diabetes Update

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We would like to make sure we are up to date on your student's diabetes care so please answer the following questions and then click the Submit button at the end.
Thank you!

Email *

Student's First and Last Name *

Does your child plan to eat breakfast here at school this year? *

Yes

Maybe

Will your child be riding the bus this year?

Yes

Maybe

Clear selection

How does your child typically check his/her blood sugar? *

Glucometer

CGM

Other:

What method of insulin delivery does your child use? *

Insulin by Syringe

Insulin Pen

Insulin Pump

Other:

What type of insulin does your child use at school?

Humalog or Lispro

Novolog or Aspart

Apidra or Glulisine

Other:

Clear selection

What type of insulin does your child use at home?

Lantus or Glargine

Levemir or Detemir

Ultralente

Other:

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What type of emergency glucagon product will you be supplying to have on hand here at school? *

Glucagon Emergency Kit

Baqsimi - glucagon nasal powder

Gvoke HypoPen - glucagon prefilled syringe

Other:

Required

Where will their emergency medication be located? *

In school office

In student's backpack

Other:

Required

Is your child independent with all daily routine diabetic cares? *

Yes

Please select any cares that you feel your child needs assistance or supervision with *

Counting carbohydrates

Calculating correct insulin dose

Drawing up correct insulin dose

Administering insulin dose

Using pump

Does not need assistance with any daily diabetes care

Assistance

Supervision

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