Current through Register Vol. 40, No. 6, March 31, 2022
(a) Glucagon: a hormone that raises the level
of glucose in the blood and is administered by injection to individuals to
treat severe hypoglycemia that is indicated by the inability to eat food or
drink, unconsciousness, unresponsiveness and/or seizures or
(b) Insulin: a hormone
made and released by the pancreas that allows glucose to enter the cells where
it is used for energy. Students with type 1 diabetes and some students with
type 2 diabetes need to administer insulin at regular times and take insulin to
cover carbohydrate intake to correct hyperglycemia.
Medication Administration and Safety: See
(d) School setting: preschool through
12th grade in a public or private school or school
activity sponsored by such a school, in which the student is a direct
Unlicensed Medication Assistant: a school employee who volunteers to receive
delegation of administration of insulin and glucagon in the school setting and
receives the approved training.
(a) The injection of insulin or glucagon is a
nursing task that may be delegated in accordance with the requirements of Act
2014-437 and the student's individualized health plan (IHP). The selection of
the type of insulin and dosage levels shall not be delegated.
(b) An Individualized Health Plan (IHP) shall
be developed for any student diagnosed with diabetes who is in the school
setting as provided for in Alabama Act No 2014-437.
(c) Delegation of tasks for students with
diabetes shall be confined to procedures that do not require nursing
assessment, judgment, evaluation, or complex skills.
Factors the school nurse shall consider
and may include in the IHP are:
1. Age of
onset and current age of student with diabetes
2. Recent hospitalization
3. Most recent hemoglobin A1C
4. Recent change in type of
insulin, delivery method, and dosage
5. If and when glucagon was
6. Comorbidities or other
in sports or other school-sponsored activities
8. Orders from a legally authorized
10. Blood glucose
11. Activation or
suspension of an insulin pump
Usage of insulin pens
Student's comprehension and adherence to treatment
15. Parental comprehension and adherence to
16. Emergency protocol
related to glucagon administration
17. Student's overall health needs
18. Insulin to carbohydrate ratios and
19. Symptoms and
treatment of hypoglycemia and hyperglycemia
20. Ketone testing
(e) Teaching school personnel about diabetes
does not constitute delegation.
Insulin and glucagon administration delegation is limited to:
1. The student's Individual Health
2. Trained, Unlicensed
Medication Assistants who have received training and competency validation for
each student assigned to them.
identified time frame
(g) The delegation shall include
documentation of administration of glucagon and insulin and appropriate
reporting to the school nurse.
If the local education agency determines that school nurses shall provide the
care to students with diabetes, delegation may not be required.
(a) The school nurse shall validate the
competency of the trained, unlicensed medication assistant to whom delegation
of administration of insulin and glucagon is given.
(b) Insulin injection by the Trained,
Unlicensed Medication Assistant receiving the delegation shall only occur when
consistent with the IHP.
Dosages of insulin may be injected by the Trained, Unlicensed Medication
Assistant as designated in the IHP.
(d) Non-routine and/or large correction
dosages of insulin may be given by the Trained, Unlicensed Medication Assistant
only after consulting with the school nurse, parent or guardian, as designated
in the IHP and after verifying and confirming the type and dosage of insulin
(e) When the
student is not capable of self-administration, routine daily meal boluses
(routine correction dosages) of insulin, based on carbohydrate counts and blood
glucose levels, may be administered by the Trained, Unlicensed Medication
Assistant as designated in the IHP.
(f) Training of the Trained, Unlicensed
Medication Assistants shall occur prior to any delegation of administration of
glucagon and insulin.
school nurse shall follow the training guidelines developed by the State
Department of Education in consultation with the Alabama Board of
(h) The local education
agency, in consultation with the school principal, shall identify any volunteer
in each school to the school nurse for possible training.
(i) An annual report of the number of
Trained, Unlicensed Medication Assistants in each school and the delegation of
administration of insulin and glucagon to specific Trained, Unlicensed
Medication Assistants shall be provided to the Board of Nursing by the Lead
Nurse of each school system.
Ala. Admin. Code r.
Administrative Monthly Volume XXXIII, Issue No. 06, March 31,
2015, eff. 4/17/2015.
Administrative Monthly Volume XXXIV, Issue No. 10, July 29, 2016,
Author: Alabama Board of Nursing
Code of Ala.
1975, § 34-21