My son and I decided he will take the ACT test without accommodations. After taking two practice tests where a real test was simulated, we knew what to eat for breakfast and what the bolus should be to keep him steady for 4 hours. He never eats a snack in the morning and generally stays steady until lunch. The sugar right before the test (taken outside the building) was a little low for an hour after eating -- 112, but he went in with the meter, pump, strips, pricker and glucose tabs in his pockets. He wasn't planning to let them know he had any of this. Other students brought cell phones, but were ordered to turn them off and put them away. Anyone who used the cell phone during the test had to go home right then (one kid did this -- unbelieveably, took it out while instructions were read to the next section and started to text). Another student was eating during a break and was told to stop and his food was taken away. Since there were watching the students like hawks, my son decided to leave everything in his pockets unless he felt low. His play, if he felt low, was to discretely eat a couple of tabs. He was able to take the test with about 15 other students in the room -- circumstances that matched his practice tests and increased his comfort level. (They had 17 other classrooms of about 20 students) Accommodations would have required he go to a room by himself. They had one break to go to the bathroom and get a drink of water and a couple of stand and stretch breaks. He ended up at 189 at 12:15 pm and felt good through the whole test. This strategy may not work for everyone, but it did for my son. Hopefully he did well enough where he won't need to take the test again.