Living with Diabetes
State Laws and Policies
Federal law provides the same protection to students with diabetes in all states. However, state laws and regulations, including the state nurse practice act and department of education and health regulations, determine who in the school setting is allowed to perform or assist with diabetes care tasks. Families, health care providers and school staff must be familiar with these laws and regulations in order to create a comprehensive school care plan.
In some states, state law explicitly restricts who can provide diabetes care in the school setting, including restricting an individual student with diabetes from self-managing his or her own disease. In other states, the issue of who can provide diabetes care is ambiguous—resulting in inconsistent care from district to district or from school to school.
Regardless of state laws about who can give care, schools are still ultimately responsible for meeting students' needs as defined by federal law.
Advocacy in states
From a practical standpoint, limits in who can provide care (and as a result, when and where care can be accessed) present a common roadblock for students with diabetes. Diabetes management throughout the school day and during school-related activities can be compromised.
In response, the American Diabetes Association and other diabetes advocates have worked to enact specific provisions regarding diabetes care in school. These provisions take the form of laws, regulations, or state Board of Nursing policies or guidelines and ensure that trained school personnel provide assistance to students with diabetes and that students who are able to do so are allowed to self-manage their disease.
Sometimes the law is difficult to interpret. To learn more about a student's rights at school or for assistance with a school discrimination issue, please call 1-800-DIABETES for more information and an opportunity to talk to a legal advocate about your specific concerns.
Your State's Laws, Regulations and Policies
The following states have passed school diabetes care legislation, regulations, or nursing policies. Learn what's going on in your state.
Every state has a number of different laws that impact diabetes care at school. The list below is only includes diabetes-specific laws.
Arizona, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin.
Arizona
Legislation
Arizona Senate Bill 1229 (2008) (PDF)
A school district may create a diabetes care policy. If the district creates a diabetes care policy:
- Students who are capable of self-care may self-administer diabetes care.
- Students may carry diabetes supplies.
- Two or more non-medical school staff may be trained as diabetes care assistants and to administer glucagon in an emergency.
Guidelines and Policy Resources
Recommended Guidelines for the Care of Children with Diabetes in Arizona Schools Arizona School Diabetes Care Guidelines
California
Legislation
California Education Code Section 49414.5 (2005) (ADA-sponsored)
- Two or more non-medical school staff may be trained to provide glucagon in an emergency.
- The training will include recognizing hypoglycemia and administering glucagon.
- Students who are capable may self-administer diabetes care.
- Students may carry diabetes supplies anywhere at school and at all school-related events.
Guidelines and Policy Resources
- California Department of Social Services Policy Bulletin for glucagon administration in child care setting (PDF)
- Glucagon Training Standards for School Personnel: Providing Emergency Medical Assistance to Pupils with Diabetes (PDF)
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Colorado
Legislation
Board of Nursing 3 CCR 716-1, Ch. XIII (8) (2007) (ADA sponsored) (PDF)
- An Individual Health Plan shall be developed for each student with diabetes.
- Trained non-medical school staff may administer insulin and glucagon, and may perform carbohydrate counting and blood glucose testing.
Guidelines and Policy Resources
Connecticut
Legislation
Title 10 Education and Culture, Chapter 170 Boards of Education, Section 10-220j (2004) (PDF)
- Students who are capable may self-administer blood glucose tests at school.
Florida
Legislation
Florida Statutes § 1006.062(4)(c) (2003) (PDF)
- Trained non-medical school staff may monitor blood glucose.
- Trained non-medical school staff may administer emergency injectable medication.
Guidelines and Policy Resources
- Florida Department of Health, Program Guidelines, Technical Assistance Guidelines and DOE Technical Assistance Papers and Notes for County School Health Programs; Nursing Guidelines for the Delegation of Care for Students with Diabetes in Florida Schools
- Diabetes Care Plan (PDF)
- Diabetes Care Plan for Insulin Pumpers (PDF)
- Governor's Diabetes Advisory Council's Position on Glucagon Administration in the School Setting
- Palm Beach County, FL School Board Rule for Blood Glucose Monitoring
Hawaii
Legislation
Hawaii Statutes § 302A-1164 (2005) (ADA sponsored) (PDF)
- Trained non-medical school staff may volunteer to administer glucagon.
- Glucagon shall be stored in a safe but easy to access location.
- School employees and the school district cannot be sued for injury resulting from administration of glucagon unless the administration involved gross negligence, gross misconduct, or willful misconduct.
Illinois
Guidelines and Policy Resources
- Illinois: Diabetes in Children - A Resource Guide for School Health Personnel (PDF)
- Recommended Guidelines for Medication Administration in Schools (PDF)
Indiana
Legislation
Indiana Statutes, Title 20, Article 34, Chapter 5, 20-34-5-1 through 20-34-5-18 (2007) (ADA sponsored) (PDF)
- A diabetes management and treatment plan must be developed by the licensed health care practitioner responsible for the student's diabetes treatment and the student's parent or legal guardian.
- An Individualized Health Plan shall be developed for each student with diabetes.
- The school's nurse shall develop the plan in collaboration with: the school principal; the student's parent or legal guardian; one or more of the student's teachers; and, to the extent practicable, the licensed health care practitioner responsible for the student's diabetes treatment.
- School nurses shall receive annual diabetes care training and may administer blood glucose tests, check for ketones, administer insulin, administer glucagon, and treat hyperglycemia and hypoglycemia.
- Each school shall recruit volunteer non-medical school staff to receive training in diabetes care and be able to administer blood glucose tests, check for ketones, administer insulin, administer glucagon, and recognize and treat hyperglycemia and hypoglycemia.
- A school may not restrict which school a student attends based on a lack of volunteer health aides at a particular school.
- Students who are capable of self-care may self-administer blood glucose tests and insulin, and may treat hyperglycemia and hypoglycemia, anywhere, anytime at school.
- The individual responsible for transporting the student to and from school shall receive an information sheet identifying the student with diabetes, explaining potential diabetes emergencies and how to respond, and providing emergency contact phone numbers.
Kentucky
Legislation
Kentucky Statutes, Title 13, Chapter 158, § 158.838 (2005) (ADA sponsored) (PDF)
- Each public, private, or parochial school shall have at least one trained school employee available during the entire school day to administer glucagon.
- The school and school employees cannot be sued for providing glucagon unless they are negligent or commit misconduct.
Maine
Guidelines and Policy Resources
- Maine Guidelines for Schools: Tools for Schools Who Have Students with Diabetes.
Guidelines developed by the Maine Department of Education and the Maine Diabetes Preventions and Control Program
Maryland
Guidelines and Policy Resources
- Management of Students with Diabetes Mellitus in Schools Maryland State School Health Services Guideline (PDF)
- Delegation of Nursing Functions to Unlicensed Direct Care Providers in a School Setting Maryland State School Health Services Guideline (PDF)
- Administration of Medication in Schools Maryland State School Health Services Guideline (PDF)
- Guide for Emergency Care in Maryland Schools (PDF)
Massachusetts
Legislation
General Laws of Massachussetts, Title 12, Chap 71, Section 54B (2005).
- Students who are capable of self-care may self-administer diabetes care.
- Students may carry diabetes supplies.
Guidelines and Policy Resources
Minnesota
Guidelines and Policy Resources
Missouri
Guidelines and Policy Resources
Montana
Legislation
MCA Section 20-5-412 (2004) (PDF)
- Allows parent/guardian to designate trained non-medical school employee to administer glucagon.
- Training must be provided by health care professional or a "recognized expert" in diabetes care selected by parent/guardian.
Nebraska
Legislation
Nebraska Revised Statutes Annotated, Chapter 79, Article 2, (d) §79-225 (2008) (ADA sponsored) (PDF)
- This law covers public, private, denominational, and parochial (religious) schools.
- Upon a parent's written request, the school and the parent or guardian, in consultation with the student's physician, shall develop a Diabetes Medical Management Plan for each student with diabetes.
- The plan shall:
- Identify the health care services
- Evaluate the student's understanding of diabetes and ability to self-manage
- Permit regular monitoring of the student's self-management by an appropriate health care professional
- Be signed by the student's parent or guardian and the physical responsible for treatment of the student's diabetes.
- The school may consult with a registered nurse or other school health care professional during development of the plan.
- The plan shall:
- Allows students who are able to self-care to self-administer diabetes care anywhere, anytime at school and school-related events.
- The school can require the parent to sign an agreement that the parent will not sue the school for injuries related to the student's self-administration of diabetes care.
Nevada
Legislation
Nevada Nursing Practice Advisory Committee Minutes (ADA sponsored) (PDF)
- School nurses may train school staff to administer glucagon, automatic devices for fixed dosage injections, and blood glucose testing.
- The trained school personnel is designated as a "qualified person."
- School nurses may train school staff to calculate and verify doses of insulin for administration via pump, pen, or syringe for self-administration by the student.
Guidelines and Policy Resources
New Jersey
Guidelines and Policy Resources
- Guidelines for the Care of Students with Diabetes in the School Setting, New Jersey Department of Education (PDF)
- NJ Department of Education notification of school diabetes care law to school district superintendents dated December 7, 2009 (Word)
New York
Guidelines and Policy Resources
- New York State Glucagon Training Curriculum and Resources
- Children with Diabetes: A Resource Guide for Schools, New York State Department of Health (PDF)
- New York School Non-medical Personnel may Administer Glucagon (PDF)
- Memorandum from NY Department of Education permitting glucagon administration by trained unlicensed personnel (March 2004)
- School Executive's Bulletin from NY Department of Education stating that it is permissible for a student to perform glucose testing anytime, anywhere and that any personnel may assist in the performance of this care task (January 2001) (PDF)
- Frequently Asked Questions About Roles and Responsibilities in Relation to Nursing Procedures and Health-Related Activities for All Children in the School Setting
North Carolina
Legislation
General Statutes of North Carolina Chapter 115C, Subchapter 06, Article 25 A § 115C-375.1 (ADA sponsored) (PDF)
- A parent may request that a Diabetes Care Plan be developed for a student with diabetes.
- The diabetes care plans will meet or exceed the American Diabetes Association's recommendations for the management of children with diabetes in the school and day care setting. This includes:
- Students who are capable of self-care may self-administer diabetes care.
- Students may carry diabetes supplies.
- If a student needs assistance, the school shall provide trained diabetes care assistants to provide blood glucose testing, insulin and glucagon administration, and to treat hyperglycemia and hypoglycemia.
Guidelines and Policy Resources
- North Carolina School Diabetes Care Legislation & Guidelines
- North Carolina Public School Diabetes Care training Curriculum, August 2005 (PDF)
- Onslow County Public School System, Agreement with (OCR)/U.S. Department of Education, May 23, 2002 (PDF)
- Henderson County Public School System, Agreement with (OCR)/U.S. Department of Education, May 2002 (PDF)
Oklahoma
Legislation
Oklahoma House Bill 1051 (2007); ( ADA sponsored) (PDF)
- A Medical Management Plan will be developed for each student with diabetes.
- The Plan will be developed by the personal health care team, which will include the principal, the school nurse if one is assigned to the school, the parent or guardian, and, if possible, the student's doctor.
- The school nurse or a school employee (volunteer diabetes care assistant) will assist the student with diabetes care.
- Each school will make an effort for a school nurse or volunteer diabetes care assistant to be available.
- Students with diabetes will not be assigned to schools based on whether there is a school nurse or volunteer diabetes care assistant.
- Training guidelines are provided for volunteer diabetes care assistants
- Information is provided for bus drivers about the student's diabetes needs
- Students who are capable of self-care may self-administer diabetes care anywhere at school.
- Students may carry carry diabetes supplies
- The school shall provide a private area for diabetes care.
Guidelines and Policy Resources
- Oklahoma Department of Health, Diabetes Control Program Recommendations for Management of Diabetes for Children in School
Oregon
Legislation
Oregon Revised Statutes, Title 36, Chapter 433, § 433.800 to § 433.830 (2003) (PDF)
- Oregon Revised Statutes, Title 36, Chapter 433, § 433.800 to § 433.830:
- Allows trained non-medical personnel to administer glucagon.
- Establishes training protocol and components.
- Trained personnel and school cannot be sued for good faith administration of diabetes care.
- Oregon Training Protocol Emergency Glucagon Providers (PDF)
Guidelines and Policy Resources
- Oregon Department of Education Revised School Health Manual
- Oregon Training Protocol Emergency Glucagon Providers (PDF)
Rhode Island
Legislation
Weil's Code of Rhode Island Rules, Agency 14., Subagency 000, Chapter 011 (2005) (PDF)
House Bill 7014 (2008) (ADA sponsored) (PDF)
- Weil's Code of Rhode Island Rules
- The certified school nurse teacher in collaboration with the student, parents/guardians, school staff, community, and health care provider(s), as appropriate will develop an Individual Health Plan and emergency health care plan for each student with diabetes and will:
- Allow students who are capable of self-care to self-test, self-treat/medicate, carry diabetes supplies, and have snacks, water and bathroom breaks when in the classroom and at school sponsored activities
- Require an adult to escort a symptomatic child to the health area
- No liability for allowing a student to carry or self-administer medication unless there is gross negligence or willful or wanton misconduct.
- The certified school nurse teacher in collaboration with the student, parents/guardians, school staff, community, and health care provider(s), as appropriate will develop an Individual Health Plan and emergency health care plan for each student with diabetes and will:
- House Bill 7014
- A parent or guardian may authorize school staff, when there is no nurse available, to provide glucagon to a student in the event of severe hypoglycemia at school or school-sponsored activities
- Training
- The staff will be trained by a doctor or nurse.
- A school nurse shall not be required to provide the training.
- The training and supervision of staff authorized to administer glucagon shall meet standards created by the Rhode Island Department of Health in conjunction with the American Diabetes Association and the Rhode Island Chapter of the American Academy of Pediatrics.
- The parent or legal guardian shall provide the school with a diabetes management plan or physician's order detailing the care and assistance needed by the student, including glucagon administration.
- Staff and the local education authority can not be sued for civil damages related to diabetes care unless there is gross negligence or willful or wanton conduct.
Guidelines and Policy Resources
- Rhode Island Glucagon Flyer (PDF)
- Rules and Regulations for School Health Programs - RI Department of Education and Department of Health June 2005 (PDF)
South Carolina
Legislation
South Carolina Code of Laws, Title 59, Chapter 63, Article 1, §59-63-80 (2005) (ADA sponsored) (PDF)
- Each school district shall require the development of individual health care plans for students with special health care needs. This plan shall be developed by: the student's health care practitioner; the parent or legal guardian; the student, if appropriate; and the school nurse or other designated school staff member.
- Unless it would seriously jeopardize the health of the student or others, students who are capable of self-care may:
- self-administer diabetes care anywhere and anytime.
- carry diabetes supplies and medication anywhere and anytime.
Tennessee
Legislation
Tennessee Code Annotated, Chapter 49-5-415 (2004) ( ADA sponsored) (PDF)
- An Individual Health Plan may be developed for students with diabetes.
- School may permit voluntary trained non-medical school personnel to assist students with diabetes care in the absence of a school nurse- NOT including insulin.
- Requires use of guidelines for diabetes care developed by Department of Education and Department of Health, including:
- recognition and treatment of hypoglycemia and hyperglycemia,
- understanding Individualized Health Plan (IHP),
- performing blood glucose monitoring
- performing ketone checks.
- Requires all school nurses to be educated in diabetes care and to have knowledge of the guidelines.
- Students may self-administer diabetes care anywhere.
- Use and disposal of sharps shall comply with Tennessee Occupational Safety and Health Administration (TOSHA) guidelines.
- No restriction on school choice.
- School nurse, trained non-medical school employee, and board of education cannot be sued for injuries resulting from reasonable and prudent assistance with diabetes care that follows the policies and guidelines developed by the departments of health and education.
Guidelines and Policy Resources
- Section 504 Manual (PDF) A comprehensive manual for Tennessee educators on Section 504 of the Rehabilitation Act of 1973
- Guidelines for Use of Health Care Professionals and Health Care Procedures In a School Setting - Tennessee Department of Health and Tennessee Department of Education (April 1, 2005) (PDF)
- Tennessee Nurses Association Glucagon Training Module (PDF)
- Tennessee Glucagon Training Knowledge Test (PDF)
Texas
Legislation
Texas Statutes and Codes, Title 2, Subtitle H, Chapter 168, § 168.002-168.009 (2005) (ADA sponsored) (PDF)
- A diabetes management and treatment plan must be developed for each student with diabetes by the student's family and physician.
- The diabetes management and treatment plan must be implemented at school through an individualized health plan created by the school principal, along with the school nurse if a school nurse is assigned to the school.
- Regardless of whether there is a school nurse, the school shall provide the services required by the plan.
- The principal shall seek school staff volunteers to be trained and to serve as unlicensed diabetes care assistants. This shall include:
- at least one unlicensed diabetes care assistant in addition to a full-time nurse at the school.
- at least three unlicensed diabetes care assistants if a full-time nurse is not assigned to the school.
- The school shall ensure that a person trained and able to provide diabetes care is available during the entire school day.
- Unlicensed diabetes care assistants shall receive training including:
- recognizing and treating hypoglycemia and hyperglycemia
- understanding the individual student's health plan
- blood glucose monitoring and ketone checks
- administering glucagon and insulin
- Bus drivers shall receive information identifying the student with diabetes and emergency instructions.
- Students with diabetes may enroll at a school even if that school does not currently have diabetes care assistants.
- Students who are able to self-care may self-administer diabetes care at all times.
- Students may carry diabetes supplies at all times.
Guidelines and Policy Resources
- Guidelines for Training School Employees Who Are Not Licensed Healthcare Professionals to Implement House Bill 984(79th Legislature) related to the Care of Elementary and Secondary School Students with Diabetes, Texas Diabetes Council (July 2005) (PDF)
- FAQs Related to Implementing HB 984 (PDF)
- Texas Guide to School Health Programs
Utah
Legislation
- Utah Code, Title 53A, Chapter 11, Part 6, § 53A-11-603 (2006) (PDF)
- Utah Department of Health press release on glucagon legislation (PDF)
- Utah Administrative Code, Commerce, Occupational and Professional Licensing, Nurse Practice Act Rules, § R156-31b-701 (2008) (ADA sponsored) (PDF
- Utah Administrative Code, Commerce, Occupational and Professional Licensing, Nurse Practice Act Rules, § R156-31b-701(a) (2008); (ADA sponsored) (PDF)
- Utah Code § 53A-11-603
- Parents may give signed permission for school staff to administer glucagon.
- When a school receives the parent's permission, it shall train and allow at least two school staff to administer glucagon.
- Schools will allow students or staff to possess glucagon so it can be accessed quickly in an emergency.
- Utah Administrative Code § R156-31b-701
- A nurse may, in accordance with a student care plan, train unlicensed school staff to administer glucagon; glucagon training must be updated at least once a year.
- Utah Administrative Code 156-31b-701a
- A student who is able to self-care may self-administer insulin.
- A nurse may train unlicensed school staff to provide diabetes care, including insulin administration.
Guidelines and Policy Resources
- Section 504/ADA Guidelines for Educators and Administrators Utah Office of Education September 2002 (PDF)
Vermont
Guidelines and Policy Resources
Virginia
Legislation
- Code of Virginia , Title 8.01, Chapter 3, Article 21, § 8.01-225(A)(9) (1999) (PDF
- Code of Virginia , Title 22.1, Chapter 14, Art. 2, § 22.1-274(E) (1999) (ADA sponsored) (PDF)
- § 8.01-25(A)(9)
- Trained school employees and school boards cannot be sued for ordinary negligence if an employee provides insulin or glucagon to a student with diabetes according to the medication schedule or because such employee has reason to believe that glucagon is needed to treat hypoglycemia.
- § 22.1-274(E)
- In a school where a student has been diagnosed with diabetes, the school board shall ensure that at least two employees have been trained to administer insulin and glucagon if there are at least 10 school staff members, and shall ensure that at least one school employee has been trained to administer insulin and glucagon if there are less than 10 school staff members.
- In a school where a student has been diagnosed with diabetes, the school board shall ensure that at least two employees have been trained to administer insulin and glucagon if there are at least 10 school staff members, and shall ensure that at least one school employee has been trained to administer insulin and glucagon if there are less than 10 school staff members.
Guidelines and Policy Resources
- Virginia Diabetes Medical Management Plans
- Virginia Board of Nursing Guidance Document: Guidelines for Training of Public School Employees in the Administration of Insulin and Glucagon (PDF)
- Virginia Board of Nursing Guidance on Medication Administration in Child Care Centers (PDF)
- Virginia Department of Education Superintendent's Memo on Training Public School Employees in the Administration of Insulin and Glucagon
- Virginia Department of Education Manual for Training Public School Employees in the Administration of Insulin and Glucagon (PDF)
- Virginia General Guidelines for Providing Health Services to the Student with Special Health Care Needs includes school diabetes care
- Loudoun County Public School Agreement with Office of Civil Rights (OCR)/U.S. Department of Education (October 1999) (PDF)
- Buchanan County Public Schools/OCR Commitment to Resolve (July 2003) (PDF)
- York County Public Schools/OCR Commitment to Resolve (August 2003) (PDF)
Washington
Legislation
- Code of Washington , Title 28A, Chapter 28A.210, § 28A.210.330 (2005)
- Code of Washington, Title 28A, Chapter 28A.210, § 28A.210.340 (2002) (ADA sponsored) (PDF)
- § 28A.210.330
- The school shall develop an individual health plan for a student with diabetes
- The school shall make exceptions, including exceptions from school policy, to allow students with diabetes to:
- eat whenever and wherever necessary
- have easy, unrestricted access to water and bathroom use
- have provisions made for parties at school when food is served, eat meals and snacks on time, and other necessary exceptions as described in the individual health plan
- ensure that school meals are never withheld because of nonpayment of fees or disciplinary action
- The school shall develop individual emergency plans for students with diabetes .
- Students who are able to self-care may self-administer diabetes care anytime, anywhere.
- Students may carry diabetes supplies.
- Parent-designated adults, who may be school employees, may provide diabetes care after training.
- § 28A.210.340
- A uniform policy for all school districts shall be created requiring inservice training for school staff about symptoms, treatment, and monitoring of students with diabetes.
- A uniform policy for all school districts shall be created requiring inservice training for school staff about symptoms, treatment, and monitoring of students with diabetes.
Guidelines and Policy Resources
- Guidelines for Care of Students with Diabetes - Diabetes/Life Threatening Conditions Bulletin61-02 (Fall 2002) (PDF)
- Washington Office of Superintendent of Public Instruction - Health Services (see DIABETES)
- Washington Office of Superintendent of Public Instruction - Health Services, Guidelines for Care of Students with Diabetes
West Virginia
Legislation
West Virginia Code Annotated, Chapter 18, Articles 1K, 2K, 3K, and 4K (2006) ("The Diabetes Care Plan Act") (ADA Sponsored)
- The Diabetes Care Plan Act, Articles 1K, 2K, 3K, and 4K
- The State Board of Education shall develop guidelines for developing, creating, and putting into action diabetes care plans for students with diabetes, which shall meet or exceed the American Diabetes Association's recommendations for the management of children with diabetes in the school and day care setting.
- These guidelines will address procedures to ensure school staff can properly assist students with diabetes , the development of an emergency plan, and will address the extent to which a student may self-care.
Wisconsin
Legislation
Wisconsin Annotated Statutes, Chapter 118, § 118.29 (2001) (PDF)
- Any school bus driver, school employee or volunteer authorized in writing by a school administrator, the board or the agency, or by a school principal, and any private school employee or volunteer authorized in writing by a private school administrator or private school principal:
- May administer a prescription drug to a pupil in compliance with the written instructions of a practitioner if the student's parent consents.
- "Administer" means to provide medication, including by injection.
- Any school employee, bus driver, or volunteer may provide glucagon in an emergency so long as that person reports the event to a medical services provider as soon as possible after administering glucagon.
- School personnel cannot be sued in civil court for administering diabetes care or authorizing other personnel to administer diabetes care unless there is a high degree of negligence.
