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November 14, 2003

School and Daycare

Question from a school nurse in Orinda, California, USA:

I need to develop policies, procedures and standards for practice in my district, and we have a Kindergarten student on an insulin pump. I am trying to maintain that I am not authorized to train unlicensed personal to deliver insulin, but the parent seems to think the school should be obligated to provide a licensed person to deliver insulin as needed. I have a 0.1 FTE position for a district with five schools. Do you think it is reasonable and legal for a five year old child to be able to deliver his own insulin pump bolus?

The parents also want to make sure someone will give their child insulin if there is a natural catastrophe, such as an earthquake. Today I spoke with the local Fire Department and learned that even paramedics are not allowed to administer insulin.

The best I can think of doing is including that the school staff should call 911 if the child needs insulin and there is no parent, no parent-designated non-employee, or no licensed person available to administer insulin. Any feedback or resources you could recommend would be greatly appreciated.


I showed your question to one of our senior nurses, and her response was that in this state it would be both legal and practical for you and some designated school person such as a teacher or a mature teacher’s aide to meet with the child’s mother to be taught how to give what I assume to be the lunch time insulin bolus. It would be wrong for the child to do this himself although quite probably he would soon learn to give the bolus under supervision.

As to emergencies, these are so unpredictable in their extent its difficult to do more than you have already planned. It might be a good idea though for the child to have a name tag saying that he has diabetes and to carry attached somewhere to his clothing a very brief summary of his insulin pump dose and of an alternative regimen if for any reason he ended up in a shelter or in hospital.


[Editor’s comment: Federal law mandates that someone in the school be trained in insulin administration if required for this child. It is the school’s responsibility to make sure there are personnel available who are trained in diabetes management. and it certainly would be inappropriate for a five year old to be responsible. There are several things I think you should do:

Download appropriate sections or obtain a full copy of the new NDEP school guide to share with school administrators that clearly supports the training of non-medical personnel to provide both routine and emergency diabetes care. In addition, it is the American Diabetes Association’s position that trained personnel must always be available on-site, and this may include the school nurse or another trained staff member.
Call 1-800-diabetes for the ADA’s comprehensive packet on school discrimination and to talk to their legal advocate.
Set up a meeting with the parents and other school personnel to establish a 504 Plan that includes an action plan for all school activities and potential disasters.