Diabetes Self-Management Blog

Every few years, controversy erupts about who should be allowed to give insulin to children with diabetes. Last November, a California judge ruled that only school nurses, not teachers or other staff trained to do the job, could give insulin injections to students in the state. This ruling followed a couple of lawsuits: First, a group of parents in the San Francisco Bay area sued their school districts and the state Department of Education so that nonmedical staff could give their children insulin. They filed the suit in federal court, arguing that their children’s right to an education was abridged because schools did not have enough medical staff on hand.

However, when the Department of Education issued new rules allowing other trained staff members to give injections, the California School Nurses Association and other groups sued, arguing that the rules violated the California Nursing Practice Act. The November ruling is the outcome of this suit. As a result, according to a recent article in the San Jose Mercury News, many parents whose children need assistance with insulin now must drive to their child’s school — or even pull their child out of school — while the state scrambles to hire more nurses. As of 2007 (when the first lawsuit was settled), on any given day, only 30% of California schools had a nurse in the building because of shared duties at multiple schools.

The Web site InsideBayArea.com ran opposing essays on this topic in December, with a piece supporting the judge’s ruling written by Dale Parent, president of the California School Nurses Association, and a piece opposing the outcome written by Dr. Francine Kaufman, a pediatric endocrinologist and former president of the American Diabetes Association. (The American Diabetes Association supported the Department of Education in the lawsuit.)

What do you think? Should trained nonmedical staff be allowed to give students insulin? Or is there too great a risk of error? Is it all right for schools not to have a nurse on hand? Leave a comment below!

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Comments
  1. I do not have a child with diabetes in the California school system. However, I myself have to take insulin before each meal. I have trained my family (husband, daughter, and nieces) to give me the insulin injections. I feel that it is important to have someone else around who knows what to do in the case of not being able to do it myself. This being said, I feel that there NEEDS to be properly trained teachers and staff at all schools, even those with a nurse. If the nurse is busy, not there because he/she is at another school, or for whatever reason unavailable, the child should not be put at risk.

    Posted by HansJenn |
  2. If you can have certified diabetes educators that can teach you how to manage you insulin and how to do injections that are not RNs, why can’t there be a ‘certified’ shot giver at each school who is NOT an RN? This issue is getting ridiculas due to who can sue whom and only the lawyers are getting anything out of it. Yes it would be great if med staff is had, but the realities of economy is that there are not - thus, we must find some compromise.

    If I can’t be there to give my child’s shot (insulin, allery, etc.), I’m willing to take a risk with having a somewhat educated adult managing it for me - this beats the 14 year old teen with no knowledge that babysits for most of us.

    Posted by abde |
  3. Yes if they know how to and it means the childs
    life then yes.
    I am a diabetic but I don’t take insluin and i don’t know how to take of give it.
    But yes s teacher may be the only hope for the child

    Posted by janieewells |
  4. I give myself 4 shots a day. I don’t see any reason someone or two can’t be trained to do them. I can’t believe the nurses would be so callous as to prevent children from getting the insulin they must have because there is no nurse all the time. In a perfect world maybe we would have a nurse at all schools, all the time, but we all know that probably will not happen.

    Posted by Marilynn |
  5. Where is that nurse when the children do their injections at home. The reasonable approach is to train staff at the schools. Nurses are not in the school when pills have to be provided to the children on a daily basis, staff does that. I am tired of hearing about court battles. Children with type 1 diabetes cannot wait for the court system to decide who can assist them. You could take this as discrimination against any disease that requires medications more than once per day no matter how it is administered.

    Posted by Airborne mom |
  6. Since they don’t or cannot have nurses at every school it makes sense to have other trained personel on staff who can give the injections. I’m sure they have others besides the nurse who can use an Automatic External Defibralato (AED) and do CPU. They should be able to train others to do it. Wonder what their responce is for the student with allergies who goes into shock and needs someone to inject them with their emergency injection pen.

    Posted by DTM |
  7. The diabetic child who takes insulin and doesn’t use a pump should have a nurse available at the school the student is enrolled in. Insulin is a potent hormone. Mistakes in dosage can be extremely serious. The seriousness of many health challenges of todays youth make me wonder why in the 21st century nurses are not part of the school staffing plan.

    Posted by Mary Jones |
  8. When the judge made this decision, I am sure he meant well, but he actually made a huge mistake. Parents and other non-medical people have been giving insulin injections for years. People on insulin don’t go to their doctors when they are on insulin to get their insulin injections each day. Parents don’t take their kids to see the doctor to get insulin injections every day.
    The other thing is that he must realize that schools are not always in a position to have enough nurses available to meet the demands and needs of kids with diabetes. Also the school nurse is responsible for all the kids in the school and cannot always be available in case of an emergency. What if the child has a low blood sugar or goes into DKA. People around that child need to be able to act and take care of that situation, including being able to give insulin or glucagon if needed.
    This judge is so wrong.
    People who are not medical professions have been giving insulin injectons for years. There is no reason that other school people can also give insulin injections, etc. if trained properly.

    Posted by deafmack |
  9. In a perfect wrld, every school would have a nurse on duty all the time. But with small schools this is cost prohibitive, and a single nurse could likely cover several schools without a problem. In this case, I think the parents should be able to appoint one or two TRAINED school employee(s) to give insulin shots to their child when needed. Not just anyone should be able to do it, and the parents ought to have the ability to choose those to be responsible for their child’s insulin shots. To not get insulin when needed can be a life threatening situation, and there is no excuse for allowing that in any school.

    Posted by Joy |
  10. I read this with interest having been an insulin dependant diabetic since the age of 13…i am now 59. Going to school was awful. I found myself not wanting to tell anyone I was diabetic. I would sneak into the boys room and into a stall if I felt like I needed a shot of insulin.The nurse had been told about me being diabetic but in 4 years of high school I never met her. I ate what i wanted and drank regular coke so not to appear different. That 4 years were proabably the worst of my growing up. I made it but someone had to have been watching out for me.

    Posted by Don Irvin |
  11. If a student is too young to give his own injection, then any trained adult should be able to provide it.

    I have been Type 1 Diabetic for 55 years and in education(teacher and administrator) for my career. I am certainly a trained adult and it does not take a great deal of training to learn this task. I have trained teachers, classroom assistants and volunteers to give injections.

    Posted by RBeathard |
  12. As a nurse, giving insulin in the hospital requires a second nurse to verify the correct dosage. Yet parents are willing to trust their child’s life to another non medical person? Even though families have been trained, they have a vested interest in the child and live the daily experience. They know the difference between hyper and hypo hyperglycemia. Expecting someone in the school to safely administer insulin is a tragedy ready to happen. Will it take the death of a child to force the school to have nurse coverage? I hope not. Getting insulin on a daily basis is not life threatening, hypoglycemia is. Every child is entitled to a school nurse for diabetes management under the IDEA act. Parents must fight for their rights.

    Posted by nurse |
  13. My Father was diabetic and on insulin. He was able to give himself his insulin shots. My Mother was taught how to measure and give him his insulin in the event he was not able to do it. there should be designated personnel at each school who are trained to give insulin shots when necessary. Insulin shots cannot wait.

    Posted by R.S.Weir |
  14. A few years ago at a MI highschool a student (18) needed his insulin which he’d left in his car. I had to wait with him in the office until an admin staffer came to go with him to the car. She then had to take the insulin from him, go back inside and watch as he injected himself. We waited quite a long time, during which this young ADULT became weak and sick. No matter how much I complained to office staff they wouldn’t budge on the matter. If he’d died, I wondered if they still would have kept the same stupid policy.

    Posted by vlj |
  15. Anyone that has been trained should be allowed to do this. The nurses UNION is only interested in keeping their members employed and nothing for the children that their actions endanger. The economy is such that the schools are being stripped of millions and teachers are being let go and the UNION wants to force the schools to hire nurses when they don’t have any money just to give nurses a job.

    Posted by dwduck12 |
  16. I started giving myself shots at the age of 7. I understand that there are a lot of children who are still afraid to give themselves shots after years of having diabetes, but I really think that the sooner a child is engaged in his own care, the better. If parents are still giving a child shots after the child is 10 and has had diabetes for more than a year, and the child refuses to inject themselves, I think it should fall on the shoulders of the parents to get the child an insulin pump that can be controlled with a remote.

    That being said, I have think it would be beneficial if the ADA or similar has a certificate program for teachers to learn how to give shots, but I think it is equally fair for the parents to have to request the teacher take the course, and the teacher has a right to refuse the course as well as the right to refuse to give a shot (otherwise, they might be abel to sue for an unfair work environment, being required to do something not teaching-related. (the principle or otherwise can do it if the teacher chooses not to.) What do the teachers’ unions have to say about this?????

    Posted by Sherri |
  17. I agree that only school nurses or parents should be allowed to administer insulin to school children. It is a violation of the Nurse Practice Act. Additionally, other trained adults do not carry the liability insurance to cover themselves should they administer an incorrect dose of insulin nor are they trained to medically intervene if they administer a incorrect dose. It would be a legal nightmare. Nurses are well-trained in the administration of insulin and treatment of medical consequences of an incorrect dose. It would be more cost efficient to hire more nurses than to have to train multiple lay people.

    Posted by mirn81 |
  18. I am a trained registered nurse and I have Type 2 diabetes requiring insulin injections 5 times a day and as necessary if my blood sugars are too high.

    My question is: who checks the students blood glucose readings to determine if they need insulin? Many children are taught to do this. Any trained nonmedical person should be able to measure and inject insulin using the new pens. Diabetics are not necessarily trained medical people. It is ridiculous to jeopardize the safety of a child with Diabetes because the schools are not properly staffed with medical personnel. Pay the nurses comparable wages and they will fill your schools or train teachers to do the job.

    Posted by genielady925 |
  19. I absolutely think that as long as persons are trained by a medical professional and subsequently approved, those children who need and are unable to administer their own shots should be able to receive them, although I’m not sure that someone would need an INSULIN injection to remedy the problem. He or she might be hypO-glycemic and would not need INSULIN, but would need to have GLUCAGON administered to RAISE the blood sugar level. That injection is absoLUTEly different from the insulin injection.
    As a 47 year old teacher with diabetes (Type I, on insulin - minimum 4-5X daily - since diagnosed at age 23), I think it is necessary for others on staff (schools, restaurants, hotels, etc?…) to be, at the very LEAST, educated about the FACTS of diabetes and possible concerns that could develop at any time of the day or night. There might then be less discrimination and/or fear due to ignorance about the condition. The first thing that needs to be done is check the sugar level to determine what course of action needs to be taken. I may be wrong, but would imagine that, more often than not, a person who is becoming incoherent or falling out of their chair is experiencing a LOW sugar rather than a high, in which case, they would need FAST-acting sugar, NOT insulin.
    I have known many children with diabetes and I know that most of them were able to administer their own injections in Kindergarten or 1st grade.
    This might be something….help the CHILDREN become more independent and learn to manage their own shots with supervision of course. J

    Posted by jaznak |
  20. I think the point is being missed. Parents assume the responsibility for giving insulin injections. It is too much to think that with the classroom environment and the unpredictability of diabetes in children, that teachers or nonlicensed individuals should have to administer insulin. Nurses have been educated to work with the diabetic patient. Even accrediting agencies recognized the potential danger of a wrong dose of insulin. Hence, insulin is double checked by 2 nurses. The potential for serious injury, including death, is to great a chance to take. I have diabetes, and would not trust my life to just anyone who can give a shot!!!

    Posted by everdill |
  21. I find it appalling that school nurses are not given the respect of being part of a students care plan. Many school districts do not want to pay for Nurses and will not even pay for the school nurses with the certified diabetes educator credentials. I for one am a CDE and do not get paid for my credential nor do I receive benefits because of being Part-time. Many non-medical personnel do not have proper training to deal with different situations, nor do they have the ability to make critical decisions when medical treatment is necessary. Why is Nursing so disrespected?

    Posted by r.wojo |
  22. As a veteran teacher I have faced many obstacles in my career but none more frightening than having a little 7 year old type I diabetic in my classroom. This young lady was diagnosed at age 2 and can check her BG herself but she still does not want to give herself shots. Her mother chose to have the teachers who would come in contact with her daughter taught about diabetes in general as well as the necessary management that was necessary to keep her in the normal ranges. This diabetes educational coordinator also taught me how to administer her shots. Over the course of the past school year our nurse went from full-time to part-time down to only one day per week because she was working another job. For this young ladies sake, I suppose it was good that I was instructed as to how to manage and administer her insulin. I spent a minimum of 6 hours 5 days a week with this little girl, shouldn’t I know her pretty well, enough to be able to look at patterns of ups and downs in her sugar levels, enough to know that exercise makes her go down and be able to figure her insulin using her carb to insulin ratio. I am saddened to see that some would rather let a little one suffer in order to prove a point.

    Posted by Concerned Teacher |
  23. My husband and I have not 1 but 2 diabetic 10 year olds - twins. They were both diagnosed prior to entering Kindergarten. We deal with the school nurse every year just before school starts. We get the orders from the doctor, talk to the nurse, and get the plan straightened out with the DOCTORS orders. When the orders are straight, we accompanied by the nurse TRAIN THE STAFF. The office staff has been the same essentially since kindergarten with a couple of changes due to retirement. I can not tell you how wonderful the staff is to our children. I think that they worry about our kids more than we do. They follow the doctors orders to the letter and call before every dose of insulin is administered to clarify that the dosage is correct with the carbs. It would be a cold day in you know where before I would vote to get rid of this caring wonderful group of women who by the way do not hold medical degrees of any kind. They are covered by insurance as long as they follow the orders as they are written. I am grateful that we live in Oregon and not California because I would sue for discrimination if my kids had to wait for life saving medication because of the greed of the nurses union or if I was forced to leave my job to do what anyone that is giveen some training can do. That is discrimination.

    Posted by MO |
  24. The real issue, that the nurses I know are concerned about, is liability and logistics. All of the people who talk about how simple this is seem to overlook these aspects in every conversation. Here are a few questions for those who think this is a simple issue.

    1. Who provides the training to these non-medical personnel?
    2. Who provides the curriculum, testing and certification?
    Remember, someone has to say that they are trained and
    competent.
    3. Who is liable if there is a bad outcome involving one of these
    non-medical personnel? Any doubt that parents of a child
    that has a bad outcome will sue the person who does or
    does not administer insulin, the person who trained them
    and the school?
    4. Who provides the continuing training? You can’t have a class
    and then not have follow-up training.
    5. If it falls to the school nurses, how do they train all of these
    teachers, secretaries, etc. and get all of their other mandated
    testing and duties accomplished?

    With the real threat of lawsuits and a nurse to student ratio 4-6 times greater than recommended, it would seem only fair that these questions be addressed in a realistic fashion. I think school nurse would be more than happy to be partners in such a plan, but right now they are simply the scapegoats.

    Posted by TJD |
  25. as a 14 year old diabetic, i am not allowed to take insulin in the classroom, is that against my rights. I think that you should have someone who could give it to you if nessicray, but i have the ability to give it to myself.

    Posted by matthew |
  26. In British Columbia,Canada Licensed Practical Nurses are allowed to give inter-muscular and Sub-cutaneous injections as part of their scope of practice. Insulin injections are given sub-cutaneously. So for the California Registered Nurses association to file a law suit saying that only they can give these injections is ridiculous. I believe LPNs are called LVNs in the USA. I would ask where the duty for service to the public fits into the nurses lawsuit.

    Posted by Angus Young |
  27. I am a insulin diabetic for now 46 years and work for a school system for 26 years. Taken them to court two times, filed four federal charges against these so called professionals. EEOC has now started to investigate four years of abuse from the school board. They have refused accommodations, told me not to check my blood glucose when needed and take insulin. They have given me 130 of at risk kids so they can kill me, refused to answer my calls for help and placed me in an overcrowded classroom to injury me. The board refuses to follow my physicians letters and just want to kill, disable and drive out. The state of florida, Tallahassee, refuses to get involved. And now you wonder why Florida is rated 49th in graduation rates for students. They don’t care.

    Posted by joe siudock |
  28. Oh if it was only as simple as just giving a shot. As a school nurse for 16+ years I worked with staff, families and students with diabetes.
    With 750 students in 2 schools the shots were the smallest of the issues for my 5-12 year olds. Counting carbs, monitoring blood sugars, treating highs and lows, communicating with doctors, trouble shooting insulin pumps on active children. Many of my teachers did not feel they could take on the job monitoring blood sugars, treating highs and lows AND teaching. The office staff did not want the responsibilty. Many people including a school board member told me “call the parent if there is a problem.” This is not right…every child with a chronic health problem should be safe at school. And it is the schools resonsibilty to provide for that safety when the students are in the building. My district cut nurses for budget reasons,I left for another job… broke my heart. Every child is entitled to a safe environment. A school nurse that is an RN needs to be full-time in every school with children who are at risk.

    Posted by melody |
  29. I find it interesting that parents would want
    well “trained” school staff to give insulin injections. I was at school one day and the “well trained” staff member was going to give a student their ADD medication. As she was about to hand the pill to the student she looked at the bottle and she had another students medication. HMMM Training teachers is not the answer - they don’t have enough time to teach the students let alone give insulin injections to all the students that need them. Schools can’t hire enough teachers as it is, and if you hire folks to train to give meds to students, well that takes away from the money to hire teachers, nurses whatever. In regards to nurses just wanting a job as some posts indicate , well most nurses just want to do what is right for the patient and in this case it is the student. Giving insulin is more than just giving insulin - it is drawing up the RIGHT amount of insulin and knowing what to do if there are problems. It is also about using that opportunity to provide some education as well. We have too many people suing for too many reasons. That is where all the money goes. I agree that with family members they have a vested interest in taking care of their loved one. That does not compare with a “well” trained “staff” member. Folks you need to go to the school and spend a day there - teachers can’t do this. Aides aren’t able to do this - they are helping the teachers. WE have diasbled children in the school system that require the use of a one on one aide. Coaches can’t do this - they are trying to take care of the masses. We need to push for nurses to be at each campus and more than one if the campus is large. There are lots of “medication” issues

    Posted by Beth |
  30. I agree with the judgement on this issue. Nurses are also afraid for their licenses as they are the ones who would take the fall if an error were made that resulted in bodily harm. I would not want to lose my livelihood over the mistakes of someone else. I would not want to have any resulting harm to a child on my conscience either.
    We also need to relax the laws that only allow bachelors prepared nurses to become school nurses. All nurses have the ability to assess and administer medications, it doesn’t necessarily have to be a nurse with a BSN or higher credentials.

    Posted by Mari |
  31. I am a school nurse and deal with this issue from time to time. It is true that family members and patients are taught and able to administer insulin to themselves at home. Just about anyone including children can learn how to do this fairly simple procedure. However, our society is one of a legal nature. You are unlikely to sue your mom or your sister if a mistake is made, but let a teacher or a secretary at school make a mistake and you will throw them under the bus! Oh yes, mistakes are harmful and someone is going to have to pay! The school nurse will go right down with them because delegating to an unlicensed person violates the nurse practice act. Until this changes and there are laws to protect well meaning people only licensed nurses should give injections. Thats just the way it is!

    Posted by Jenny |

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