DiSH-MT: Diabetes Orders in Montana

In this session, we reviewed Montana clinical diabetes processes and workflows for school diabetes orders and management plans, current Montana diabetes management plans and resources, and looked at what diabetes clinics across the state are utilizing.

DMMPs are the healthcare provider’s orders for how to care for the student with diabetes, including insulin and glucagon orders and how/when to monitor sugars.
Every child with Type 1 Diabetes should have a Diabetes Medical Management Plan (DMMP), which should be reviewed with the school, family, and clinic and updated yearly.
Remember through all these details, that a kid is a kid first, and their diabetes care at school should keep them in the classroom, games, and activities as much as possible. Where safe to do so, aim to limit trips to the nurse/office when designing their diabetes care plan.
DPHHS School Health website diabetes pages:
- Teacher/student video – diabetes care in the classroom
- Coach video – “Don’t Keep Them Out of the Game”
- Provider order templates for pumps, injections
- Blood glucose algorithm

There are plans to update the state orders! Anyone interested in being part of the group, or sharing their thoughts, should contact diabetes@montanapediatrics.org. When we have specific details about participation in the coming weeks, we will let you know!

If you’re interested in helping update and improve the Montana-crafted DMMP (developed in 2018 by Montana Kids with Diabetes School Collaborative), or know a school nurse, state public health leader, parent or school leader who may be a good fit, please contact diabates@montanapediatrics.org and we’ll get you connected!
Don’t hesitate to reach out to a student’s clinic team if you don’t have up-to-date orders.
Technology keeps changing and students on automated insulin delivery systems, where the pump communicates with the continuous glucose monitor (CGM), orders may have more details regarding exercise and treatment of lows. Look for these differences if you know your student has newer diabetes technology!

Is the DMMP the same as the 504 plan?

The DMMP is separate from the 504 plan. Both should be implemented collaboratively with the healthcare team, school nurse, parent or guardian, student, and other school personnel. For more info on 504 plans, see the American Diabetes Association’s resources within their Safe at School site.
What ideas does the group have to improve the current Montana DMMP?

Discussion around this focused on making sure the tool empowers school nurses to provide the best up-to-date care for students with diabetes by including: more guidance on exercise and sports; more information for kids on pumps (e.g. what to do if the pump fails, as well as nuances for new technology); more guidance on CGM responsibilities; and, clarification of responsibility for assessing a student’s self-management skills (parent? clinic?).
Can we get all these resources housed in one place?

We hope so! Between Montana Pediatrics and Montana DPHHS, we hope to continue to facilitate access to high-quality resources for Montana School Nurses. Additionally, there is more programming to come via the National Association for School Nurses (NASN) via another Helmsley Grant to support an updated Type 1 Diabetes curriculum with state-specific resources in Montana. See this announcement and stay tuned for more to come soon.