House Bill 984, passed in the 79th regular legislative session, requires each student with diabetes to have a diabetes management and treatment plan developed by the parent and the student’s doctor. The plan must identify the services the student may receive at school and evaluate the student’s ability to self-manage. An individual health plan, incorporating components of the student’s diabetes management and treatment plan, also must be developed by the school nurse and principal for students seeking care for diabetes while at school or while participating in a school activity. The principal must identify school employees (other than health care professionals) to serve as unlicensed diabetes care assistants, who will be trained to assist with daily or emergency care of students with diabetes if/when a school nurse is not available. The principal must ensure that the school has at least one unlicensed assistant if the school has a full-time nurse; if there is no full-time nurse, the school must have at least three unlicensed assistants. A school employee may not be subject to any penalty or disciplinary action for refusing to serve as an unlicensed diabetes care assistant.

As mandated by the legislation, the Texas Diabetes Council, with the assistance of key organizations, has developed guidelines for schools to use in the required training of school employees to serve as unlicensed diabetes care assistants. According to the guidelines, both a written test and a skills check must be passed for an individual to be designated as an unlicensed diabetes care assistant. Training should be provided by a health care professional before the beginning of the school year or as soon as practicable after the enrollment or diagnosis of a student with diabetes, and should include at least the following elements:

  1. understanding the essential elements of the individual health plan;
  2. recognizing the signs and symptoms of low blood sugar/glucose (hypoglycemia) and high blood sugar/glucose (hyperglycemia) levels;
  3. understanding and knowing how to take or help the student take proper action if the blood sugar/glucose and/or urine ketones are outside the range indicated by the student’s diabetes management and treatment plan;
  4. performing or assisting a student with monitoring of blood sugar/glucose and/or urine ketones using a monitor provided by the student’s family and/or urine testing strips for ketone evaluation and recording the results;
  5. knowing how to safely and properly administer insulin and glucagon according to the student’s diabetes management and treatment plan and individual health plan, and how to properly record the action;
  6. knowing and recognizing the signs and symptoms and blood sugar/glucose levels that require emergency assistance and how to take proper action;
  7. knowing and understanding the nutritional needs of students with diabetes, including but not limited to the need for regular meals, how snacks are utilized in the daily regimen of children with diabetes, how exercise affects blood sugar/glucose, and how changes in schedules, such as illness, tests and field trips, can affect children’s nutritional needs; and
  8. knowing when to call the child’s parent(s), a health care professional and/or 911 for help.

Parents must sign an agreement before the assistant is allowed to help the student, which includes a statement that the parent understands that an unlicensed assistant is not liable for civil damages. (TCTA was successful in adding language to this 2005 legislation to avoid the creation of potential liability for school employees.)

The law also requires schools to allow students to self-check, self-medicate and have diabetes supplies and equipment in class, on school grounds or at any school-related activity in accordance with the student’s health plan. In addition, school districts must give written diabetes information to employees who transport or supervise a student with diabetes during off-campus activities.

The complete training guidelines, including a sample skills checklist, pre- and post-training test with answers/discussion points, glossary and resources, are available on the Texas Diabetes Council’s Web site at, with updates to be provided as needed.