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The Virginia DiabetesCouncil ( VDC) is working to increase access to evidenced-based resources andpromote self-awareness and self-management of diabetes. The VDC encourageshealth care providers and people with diabetes to use the following highquality resources for diabetes management and control.

     Here is the latest NDEP information for school personnel workingwith students with diabetes.


School Resources,Forms and Protocol 2016-17

TheVirginia Diabetes Medical Management Plan and Protocol: A Supplement to theNational Diabetes Education Program’s Helping the Student with DiabetesSucceed: A Guide for School Personnel is to be used as a quick reference guideto promote and ensure excellence, safety and support for children with diabetesin Virginia’s schools.

Virginia Diabetes Medical Management Plan and Protocol Supplement-School Forms




The Virginia DiabetesCouncil and the Department of Education, Office of Student Services supports the use of the these school forms as a way to provide quality and standardizedcare for children with diabetes in all school systems in Virginia.


Virginia School Diabetes Medical Management Forms (DMMP)Click Here

 Revised June 2016

Part 1- School nurse distributes this form to the parent/guardian to determine permission or denial of permission for insulin and/or glucagon administration by trained unlicensed personnel.

Part 2 -- Physician distributes these forms to parents to sign and bring to their child’s school to authorize communication between the school and physician on diabetes care.

  • DMMP Intensive Therapy
  • DMMP Conventional Therapy

Part 3 - If the child wearsan insulin pump, then this form needs to be completed by the physician and theparent/guardian to provide child’s proficiency of pump operation and where theywill require assistance/supervision.
  • Pump Therapy Supplement

Part 4 – If the child is going to carry or self administer insulin and/or perform blood glucose checks in the classroom, this form is recommended to be completed by the physician, school nurse and parent/guardian to inform everyone of expectations and responsibilities.

  • Permission to Self Carry
Other Recommended School Resources: