Advocacy

Education Setting Materials for Attorneys

American Diabetes Association (ADA) resources, information, and guidance to assist with advocating on behalf of children with diabetes in school, childcare, and other community settings.

Diabetes Care in the School Setting
Diabetes Care® Volume 47, Issue 12 (Dec. 2024)
This official statement contains the ADA’s views on the provision of necessary and appropriate diabetes care in the school setting.

Legal Rights of Students with Diabetes
(James A. Rapp, JD, et al.) (Mar. 2015)
A comprehensive guide for advocates and attorneys on the legal rights of students with diabetes. It contains information on the law, strategies for securing these rights, procedures for resolving disputes, forms, and other resources.

Legal Protections for Students with Diabetes
Find an overview of state laws related to students with diabetes, information on cellphone restrictions in schools, and a brief overview of federal laws (Section 504, the Americans with Disabilities Act, and the Individuals with Disabilities Education Act) that provide legal protection to students.

Health Privacy Laws in the School Setting FAQ
These FAQs provide an overview of Health Insurance Portability and Accountability Act and Family Educational Rights and Privacy Act and how the laws interact in the school setting.

Helping the Student with Diabetes Succeed: A Guide for School Personnel
(American Diabetes Association, 2022)
This guide is designed to educate school personnel, parents/guardians, health care professionals, policy makers and others about best practices for the provision of diabetes care in the school setting, meeting the needs of the individual student, and legal protections for students with diabetes. This guide includes sample forms and describes the roles and responsibilities of stakeholders.

Sample Written Care Plans 
The ADA offers a sample Section 504 Plan and Diabetes Medical Management Plan that can be freely used by families, schools, and providers to set out individualized diabetes care, services, and accommodations. 

Going to College with Diabetes: A Self Advocacy Guide for Students 
(January 2025)
This  self-advocacy tool for post-secondary students and advocates includes information on students’ legal rights, postsecondary institutions' legal obligations, strategies for obtaining reasonable modifications and accommodations, tips to help students manage their diabetes in a new environment, sample forms, and information for when a formal complaint or legal action may become necessary.

Care of Young Children with Diabetes in the Childcare and Community Setting: A Statement of the American Diabetes Association 
(October 2023)

This official statement contains the ADA’s views on best practices for the provision of diabetes care and in the childcare setting and legal protections for children with diabetes.

Legal Resources and Citations 

Administrative decisions are issued by government agencies which have responsibility for investigating individual cases of discrimination and enforcing specific laws. Administrative decisions or settlement agreements are generally only legally binding on the parties involved in the case. This means that the same agency could come to a different conclusion when investigating a similar case. Additionally, determinations of “reasonable accommodation” are by an individual assessment, so these accommodations may differ from student to student. While administrative decisions are not legally binding to other cases or situations, they may be a helpful advocacy tool. 

State Administrative Rulings and Settlement Agreements

Inadequate Provision of Services/Accommodations

  • Northport Public School District, 116 LRP 31017 (Mich. July 20, 2016)
    A case involving child with autism spectrum disorder and type 1 diabetes who raised claims related to special education for autism and related services for diabetes. Where the student's medical care plan didn't require it to test her blood glucose in a specific location or provide her an environment free of candy, and a teacher's single testing error was an isolated incident, there was no failure to follow the care plan.

Diabetes and the IDEA 

  • Prince George’s County Public Schools, 121 LRP 26276 (MD March 4, 2021) 
    Finding that violations occurred where the initial Individualized Education Program (IEP) was not designed to address the student’s needs nor the needs related to diabetes. Despite prior written notice for the initial IEP meeting that diabetes impacts the students access to instruction, the IEP did not address the need.
  • Bryant School District, 69 IDELR 198 (Ark. Dec. 23, 2016) 
    Student’s “constant monitoring and frequent treatment” for her diabetes did not impact her educational performance, and thus an IEP was not necessary to provide Free Appropriate Public Education (FAPE)[CG1] . Since parents did not request an evaluation, and her educational performance did not appear to be diminished, the district did not violate IDEA.
  • In re: Student with a Disability, 115 LRP 50968 (SD July 18, 2014) 
    Where a student’s diabetes accommodations were incorporated into an IEP and diabetes had a significant effect on the student’s behavioral disability. The district violated the IDEA when it modified the IEP regarding blood glucose level testing without considering the diabetes management plan or consulting medical providers.
  • Clark County School District, 114 LRP 45477 (Nev. Aug. 28, 2014) 
    Parents’ repeated statements to school employees regarding inadequate care of the student’s diabetes and their belief that such inadequate care was affecting his educational performance did not trigger the school’s Child Find obligations under IDEA because the parents’ concerns would have been rectified by appropriate diabetes care. Nothing in the parents’ requests indicated that special education was necessary.

Refusal to Provide Required Services

  • Tunkhannock Area School District, 115 LRP 36528 (Pa. June 11, 2015) 
    Ruling that a Pennsylvania district’s refusal to let anyone other than the school nurse administer glucagon to a second grader with diabetes resulted in disability discrimination under Section 504 of the Rehabilitation Act, regardless of whether state law permits a trained, unlicensed staff member to administer it.

U.S. DOJ Administrative Decisions and Settlement Agreements 

Continuous Glucose Monitoring 

  • Metro Nashville Public Schools (USAO 2024V00065 - DJ# 202-71-161)
    An agreement to resolve allegations that Metro Nashville Public Schools and Ross Early Learning Center violated the Americans with Disabilities Act by refusing to allow certain communications related to continuous glucose monitoring on behalf of a three-year-old student with type 1 diabetes. The school required the parent and/or child to be responsible for monitoring the child’s continuous glucose monitor (CGM) when the school nurse was not at school and would not use a device to monitor the CGM. The school agreed to modify the District’s policies, practices, and/or procedures to permit the use of CGMs by children diagnosed with type 1 diabetes, who are prescribed the devices, to purchase or use existing equipment to monitor CGMs and to provide appropriately trained staff, among other agreements.
  • Creative Interventions, LLC – U.S. Attorney’s Office, District of Connecticut (2024) 
    A settlement agreement to resolve allegations that the company discriminated against a child with autism and type 1 diabetes, and the child’s parents, by refusing to monitor the child’s CGM and by refusing to provide other routine diabetes care. The government found that monitoring the child’s CGM and providing other routine diabetes care specified by the child’s care plan were reasonable modifications under the Americans with Disabilities Act that Creative Interventions staff should have provided.
  • U.S. Attorney’s Office, District of Connecticut, Closing Letters, Continuous Glucose Monitoring

OCR Agreements

The U.S. Department of Education’s Office for Civil Rights (OCR) is responsible for enforcing the rights of students with disabilities under Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. Below are several OCR decisions and settlements addressing students with diabetes.

Failure to Implement a 504 Plan

  • Cañon City Schools (2021) (PDF) 
    Resolution agreement regarding alleged failure to implement a 504 Plan and discrimination by failing to provide the Student with insulin and check ketone levels as indicated in their 504 Plan. The District agreed to provide proper staff training, including in devices or materials such as an insulin pump necessary to manage the Student’s diabetes in a school setting, train staff on Section 504 requirements, and to reconvene a Section 504 meeting.
  • Westminster (CO) Public School District, 125 LRP 3597 (2024) 
    OCR determined that a district may have violated Section 504 and Title II when it allegedly failed to properly implement the 504 Plan of a student with diabetes. OCR found that staffers failed to document the student's blood glucose levels, to consistently recognize symptoms of health changes, and to document communications with the school nurse or parent. Some staffers did not receive appropriate training in administering insulin.
  • Lincoln Preparatory Academy (AZ) (2016) (PDF) 
    OCR finding of failure to implement the student’s 504 Plan and failure to evaluate where the transfer student provided an existing 504 Plan during his May enrollment, but the school did not acknowledge the plan until mid-December. The School’s implementation of a medical management plan did not excuse failure to implement a 504 Plan, as the medical management plan did not contain several of the accommodations laid out in the 504 Plan.

Finding of Discrimination

  • Park City (UT) School District (2016) (PDF) 
    OCR ruled that the district violated Section 504 when it asked parents of children with diabetes to attend field trips, because it did not do so for students without disabilities. The District’s explanation that it only did so when nurses weren’t available was not a legitimate excuse.

Field Trips and Extracurriculars 

  • Terrell County (GA) Charter School System, 120 LRP 31716 (OCR, 2020) 
    A Georgia district resolved OCR concerns that it discriminated against a second grader with diabetes when it denied her the opportunity to participate in Saturday school and a field trip unless her parent accompanied her to administer insulin. The district agreed to convene a meeting to review and revise the 504 Plan so the student can participate in non-academic and extracurricular activities. Additionally, the district agreed to train staff on 504 Plan implementation and emergency care for students with diabetes. 

Failure to Evaluate

  • Leona Group and Discover U Elementary School, 124 LRP 7217 (2023) 
    A Charter school may have violated Section 504 and Title II when it failed to timely evaluate and develop a Section 504 Plan for a kindergartner with diabetes by requiring the student to go through a 45-day screening process before evaluation of a 504 Plan. The school executed a resolution agreement and promised to issue a training memorandum to all relevant staff and audit its files to ensure all eligible students received 504 Plans.
  • Hesperia (CA) Unified School District (2015) (PDF) 
    OCR finding of noncompliance where parent requested evaluation due to the student’s ADHD and diabetes and district denied services based on an evaluation of his ADHD alone. The Student’s numerous nurse visits for diabetes were sufficient to cause the school to evaluate the student for special education and related services to address his diabetes.

Denial of FAPE

  • Natrona County (WY) School District, 125 LRP 21219, (OCR, 2025) 
    OCR noted compliance concerns regarding the provision of FAPE to a student with diabetes where the school required family members to come to school or field trips to administer insulin or miss school when the school nurse was absent. The school agreed to revise its disability policies and regulations, train staff on obligations to provide FAPE, and include a statement in training that the District cannot require family members to administer insulin and glucagon. Also see Sarasota County (FL) School District (2012).

Service Animals

  • Cullman County (AL) Schools (2017) 
    Applying the Title II service animal regulations, 28 C.F.R. § 35.104, as well as Section 504, OCR found that a district that refused to allow a student to travel with his service animal on the school bus without certain documentation violated the Americans with Disabilities Act and Section 504.

Landmark OCR Cases and Resolution Agreements 

  • Irvine Unified School District (1995) (PDF) 
    Explaining OCR’s interpretation of 34 C.F.R. 104.4(b)(1)(v) which prohibits recipients of federal funding from providing “significant assistance” to entities that discriminate on the basis of disability, which here, was an after-school program.
  • Henderson County (NC) Pub. Schs., 34 IDELR 43, 44 (OCR 2000) 
    A voluntary resolution agreement to develop a Section 504 Plan providing diabetes-related aids and services, including training of staff to monitor blood glucose, administer glucagon, count carbohydrates, manage a student’s insulin pump, and provide other appropriate emergency services. Additionally, the school agreed to have an individual who is trained to operate an insulin pump accompany the student to school-sponsored events off campus.
  • Loudoun County (VA) Pub. Schs., 102 LRP 3258 (OCR 1999) 
    Resolution agreement to designate at least three full-time trained staff to provide diabetes care, train staff, required school to allow access to food and drink, allow access to use a restroom, and be excused to see trained staff or medical personnel. Additionally, the school agreed to develop and implement a health care plan a Section 504 Plan for each student with diabetes.

Court Cases

M.F., et al. v. New York City Department of Education 

In 2018, the ADA joined with three families to bring a class action lawsuit concerning the provision of diabetes care and access to accommodations and related services in New York City public schools. On April 21, 2023, the U.S. Eastern District Court of New York approved a settlement agreement to resolve a lawsuit between the ADA and three families, and New York City, the Department of Education, the Department of Health and Mental Hygiene, and the Office of School Health. 

K.C., et al. v. O'Connell, et al. and American Nurses Association, et al., v. Torlakson, et al.
In 2007, the ADA settled a lawsuit against the California Department of Education and two school districts regarding diabetes care in California public schools. The settlement included a legal advisory designed to inform school districts of their legal obligations to serve students with diabetes. After the settlement, several nursing organizations filed suit to challenge provisions of the legal advisory relating to who may administer insulin to students. The California Supreme Court sided with the ADA and ruled that California law permits trained, unlicensed personnel to administer insulin. Learn more about the settlement and litigation materials of the case.

R.K. ex rel. J.K. v. Bd. of Educ. of Scott Cnty., Ky., 637 F. App'x 922 (6th Cir. 2016)

This case challenges a Kentucky school district’s policy requiring a student with type 1 diabetes who is not yet able to self-administer insulin to transfer to another school that has a full-time nurse, rather than being able to receive needed care at the school he would otherwise attend. The district court granted summary judgement to the school board after remand. Upon appeal of the district court decision, the court held that R.K. was not entitled to relief. In part because the request for injunctive relief was moot as Kentucky amended KRS § 158.838 to provide that a school shall not prohibit a student with diabetes from attending any school on the sole basis that the school does not have a full-time nurse. 

CTL v. Ashland Sch. Dist., 743 F.3d 524 (7th Cir. 2014)

In this case, parents filed suit challenging the school’s failure to implement their child’s 504 Plan’s requirement that there be two trained diabetes personnel as back-ups to the school nurse. The Seventh Circuit affirmed the District Court’s grant of summary judgment to the school district. In so doing, the Court explained that for 504 Plan violations to constitute disability discrimination, they must be significant enough to effectively deny a disabled child the benefit of a public education. The school district's failure to train two additional staff members was at most a minor violation of the 504 Plan and thus did not deny him the benefit of a public education.

B.A.T.M. v. School Board of Pinellas County Administrative Hearing

In a Florida state administrative hearing, parents of a child with type 1 diabetes challenged a school district policy requiring their child to be transferred to a different school where there was a full-time school nurse, despite state law that permits school districts to train unlicensed school personnel to administer insulin and other diabetes care to children. A state hearing officer ruled that the district’s policy violates Section 504 because it does not provide for individualized assessment of the needs of the child.