CGM Basics

Sample 504 Plan for Students with Diabetes Using CGM

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This resource is a sample 504 Plan that can be used as a foundation for an individual 504 plan. Parents, teachers, and healthcare professionals should work together to personalize the plan for each individual.  This sample 504 plan is not meant to offer any medical advice and should be approved by a treating healthcare professional.

504 plans for students with diabetes often include: 

  • Times when trained diabetes personnel will be available
  • Level of self care
  • Access to diabetes supplies and equipment
  • Access to snacks, water and bathroom
  • Medication and insulin therapy plan
  • Low and high glucose treatment plan
  • When to call the main caregiver
  • Information about CGM use in a school setting

Sample 504 Plan (DOC) 

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