Approximately 215,000 or 1.8 in 1,000 school age youth have been diagnosed with Type 1 or 2 diabetes within the United States. Accordingly, based on the National Association of School Psychologists (NASP, 2010) recommended caseload of 500-700 students, a school psychologist should be prepared to work with 1 to 2 youth and their families managing diabetes as part of his or her annual caseload. It is important for school psychologists to recognize that children with diabetes might be at risk for cognitive and academic impairments. The purpose of this article is to: (1) review the etiologies, symptoms, and treatments of Type 1 and 2 diabetes; (2) discuss the impact of diabetes on achievement and cognition; (3) review applicable federal laws; (4) identify the importance of diabetes care plans in school; and (5) discuss making decisions related to eligibility for specialized instruction and accommodations. A case study and functional assessment approach related to eligibility decisions is presented.