[Date]
[Name and Title of Principal/504 Coordinator]
[Name and Address of School]
Dear [___________]:
My patient [patient’s name] has been diagnosed with type 1 diabetes mellitus, a
lifelong disease that substantially limits endocrine function. Specifically, [his/her]
body does not produce insulin. Insulin is necessary to convert glucose, which
comes from food, into energy that the body can use. Management of diabetes
requires the ongoing continuous balance of insulin, physical activity, and food
intake at home and school. Without the constant balancing of these factors,
[he/she] would be placed at increased risk for serious short-term complications
such as life-threatening hypoglycemia and diabetic ketoacidosis and/or long-term
medical complications such as blindness, kidney and heart disease, amputation
and more.
My patient’s parent/guardian is making a request for the inclusion of COVID-19
related provisions in his/her Section 504 or other written accommodations plan
due to the COVID-19 pandemic. Students with diabetes have legal rights and
these rights do not go away during a global pandemic. Parents and schools
should work together to create a safe, healthy, and supportive learning
environment for students with diabetes.
People with uncontrolled diabetes (HbA1c>10) and associated complications
(kidney disease, obesity, hypertension, metabolic syndrome, etc.) face a higher
chance of experiencing serious complications from COVID-19. The CDC and
many state governments have advised people with uncontrolled type 1 diabetes
and type 2 diabetes to stay home to avoid exposure to the coronavirus. The
CDC has advised all people with diabetes to undertake social distancing and
practice other precautions when not at home. With many schools soon reopening, we want to make sure the risk of COVID-19 is minimized for my patient.
In general, people with diabetes are more likely to experience severe symptoms
and complications when infected with a virus. For example, viral infections can
increase inflammation, or internal swelling, in people with diabetes. This is also
caused by above-target blood sugars, and both could contribute to more severe
complications.

2451 Crystal Drive
Suite 900
Arlington, VA 22202
1-800-DIABETES (342-2383)

 As referenced above, when sick with a viral infection, people with diabetes also
face an increased risk of DKA (diabetic ketoacidosis). DKA can make it
challenging to manage fluid intake and electrolyte levels—which is important in
managing sepsis. Sepsis and septic shock are some of the more serious
complications that people with COVID-19 have experienced.
In the case of my patient, it is my professional opinion that the risk of serious
illness related to COVID-19 can be reduced by including following COVID-19
related provisions in my patient’s Section 504 or other written accommodations
plan. Some of these provisions include, but are not limited to:
(1) small in-person class sizes;
(2) same group of students rather than mixing between groups;
(3) staggered, rotating and/or alternate day scheduling;
(4) maintain at least 6 feet social distancing between desk and students
and on the school bus;
(5) stagger arrival and dismissal times;
(6) prohibitions against sharing objects such as musical instruments and
keyboards;
(7) clean and disinfect desk, counters, doorknobs, handles, light switches,
electronics, metal/plastic playground equipment, drinking fountains, toilets,
sinks, faucets, and other surfaces;
(8) post signs throughout the school and make frequent announcements
to promote handwashing and appropriate social distancing;
(9) soap, water, and hand sanitizer should always be readily available;
(10) encourage the wearing of cloth face coverings/masks – especially
when social distancing is difficult ;
(11) stagger playground usage by classes;
(12) provide an area of isolation or separate health clinic for students
experiencing COVID-19, flu or other symptoms of illness;
(13) provide a separate well-health clinic for medication and first aid;
(14) limit activities where large groups of students are in close proximity
and revise to a small group gathering;
(15) minimize mixing of students in the hallways and other common areas;

2451 Crystal Drive
Suite 900
Arlington, VA 22202
1-800-DIABETES (342-2383)

 (16) permit additional sick days as needed;
(17) separate clinics to keep ill students and staff from students who travel
to the clinic for medication or first-aid; and
(18) full participation in all school-sponsored activities.
With these added provisions, [patient’s name] can minimize [his/her] risk of
infection while safely accessing the school environment and fully participating in
school-sponsored activities. Please contact me if you have any questions.
Sincerely,

[Dr. Signature]
[Printed Name]

2451 Crystal Drive
Suite 900
Arlington, VA 22202
1-800-DIABETES (342-2383)