SAT and ACT Testing Accommodations for Diabetes, Epilepsy, and Severe Allergies

A student with type 1 diabetes sits down for the SAT. Forty minutes in, their CGM alerts for a dropping glucose level. They need to check their blood sugar, eat a fast-acting carb, wait 15 minutes for levels to stabilize, and then resume — but the proctor says no food, no phone, and no breaks outside the scheduled intervals.

This is exactly the situation that testing accommodations prevent. And if your child has a 504 plan at school, they are entitled to request accommodations on the SAT, ACT, AP exams, and state standardized tests.

How Testing Accommodations Work for Medical Conditions

Both the College Board (SAT/AP) and ACT, Inc. have formal accommodations request processes for students with documented disabilities, including chronic medical conditions covered under Section 504.

The accommodations most relevant to students with diabetes, epilepsy, or severe allergies include:

• Extended time: Extra time per section to account for glucose checks, medication effects, or post-seizure recovery. ACT offers options such as 50% or 100% extended time; each testing body decides what it approves.
• Extra breaks: Additional breaks between and during sections for blood sugar monitoring, insulin dosing, snacking, or medication administration
• Food and drink access: Permission to bring glucose tablets, juice boxes, snacks, and water into the testing room
• Medical device access: CGM receiver or smartphone kept at the student's desk with alerts enabled (not in a collection bag at the front of the room)
• Separate testing room: Reduces distraction from CGM alarms and allows privacy for medical management
• Stop-the-clock provisions: If a medical event occurs mid-section (hypoglycemia, a seizure, an allergic reaction), the clock stops until the student is medically stable and ready to resume
• Rescue medication at desk: EpiPen, Baqsimi, Nayzilam, or other rescue medications accessible within arm's reach, not in a proctor's bag across the room

The Application Process

SAT and AP Exams (College Board)

The school's 504 coordinator or SSD (Services for Students with Disabilities) coordinator submits the request through the College Board's SSD Online portal. The strongest applications include:

1. A current 504 plan documenting the student's medical condition and school accommodations
2. The physician's medical management plan (DMMP, Seizure Action Plan, or Allergy Action Plan)
3. A history of the student using these accommodations in school — the College Board looks for consistency between what the school provides and what is requested on the test

Submit early through SSD Online: a new request may take up to seven weeks after all required documentation is received. Check the published SSD deadline for the test date. If the initial request is denied, the College Board has a reconsideration process, and additional medical documentation can strengthen the appeal.

ACT

ACT, Inc. uses a similar process through its TAA (Test Accessibility and Accommodations) system. The school submits documentation showing the student's disability, current accommodations, and a history of their use. ACT approvals align closely with what the student already receives under their 504 plan.

State Standardized Tests

State assessments (STAAR in Texas, CAASPP in California, PARCC/MCAS/Regents in other states) have their own advance approval procedures. A 504 plan can document the student's routine needs, but do not assume every classroom accommodation automatically carries over; confirm the approved accommodations with the state or district testing coordinator.

What to Put in the 504 Plan Now

Testing accommodations on the SAT and ACT are far easier to get when they mirror what the student already receives at school. If your child's 504 plan does not include testing-specific language, add it at the next annual review:

• Permission to check blood glucose and treat before, during, and after any test
• Stop-the-clock provision: if blood glucose drops below 70 mg/dL or rises above 250 mg/dL with ketones, testing pauses until levels return to the target range (80–180 mg/dL) for at least 20 minutes
• If a seizure occurs during a test, the student rests in a quiet area for the full post-ictal recovery period and completes the test at a later time without penalty
• CGM and smartphone access at the student's desk during all assessments
• Rescue medication within reach during testing

This documentation creates the paper trail that the College Board and ACT need. Starting in middle school means several years of consistent accommodation history by the time college entrance exams arrive.

When Accommodations Are Denied

If the College Board or ACT denies an accommodations request, appeal with additional documentation: a letter from the treating physician explaining the medical necessity, updated glucose logs or seizure records showing the frequency and impact of episodes, and a statement from the 504 coordinator confirming the school's accommodation history.

If the testing organization denies a request, use its review or reconsideration process and keep the denial with the student's supporting documentation. Testing approvals are handled by each testing body.

The Medical 504 Plan Toolkit includes testing accommodation language for diabetes, epilepsy, and allergies that you can add to your child's 504 plan, along with a checklist for SAT/ACT accommodation applications.