In court papers, the girl is identified only as "A.A.," a student in the San Ramon Valley school district.

Five years old when the lawsuit was filed in 2005, A.A. is diabetic. She requires testing of her blood glucose eight to 10 times daily and insulin injections four to five times. When A.A. was first enrolled in kindergarten, the school principal told her mother that she would have to be on-call at all times to administer the insulin.

A.A.'s parents were not alone. Across the state, parents and district officials were struggling to care for diabetic students during school hours. Under federal law, schools are required to provide assistance to students with disabilities. But some school officials were refusing. A lawsuit followed and, finally, last year a settlement was reached with the state Department of Education.

Under the deal, when possible, school nurses would administer insulin. When they weren't available, other school personnel, who would receive special training, would provide the injections. It was a reasonable solution — one wholeheartedly endorsed by the American Diabetes Association, most medical groups and disability advocates. After all, parents learn how to administer insulin to their children; certainly other adults can learn too.

But it's a solution the California Nurses Association had successfully lobbied against in Sacramento for years. Having convinced lawmakers to only allow nurses to administer insulin, the union didn't want the state Department of Education to use a court settlement to get around the rules. So the nurses association challenged the settlement in court and a judge ruled this month that, indeed, state law only allows nurses to give shots at school.

It's an example of what happens when one organized group has political clout in Sacramento and is more interested in protecting jobs than resolving problems.

Next time your local school officials come begging for another parcel tax, increase class sizes or cut out high school electives, think about the California Nurses Association.

Yes, the insulin-injection fight is just a small part of a much bigger financial problem. But opposition to the settlement creates yet another financial demand on already struggling school districts that face more cutbacks because of a $28 billion state budget shortfall.

The treatment of diabetes in students poses a serious problem for schools. By one estimate, about one of every 465 children in California public schools has Type 1 diabetes that requires insulin injections. That works out to roughly 13,500 children statewide. They don't all need insulin injections and many of those that do are old enough to administer it themselves without supervision.

But there are only 2,829 school nurses across the state. According to the state Department of Education, it's the worst ratio in the nation. Moreover, nearly half of all school districts have no nurse at all. Even under the unrealistic assumption that all of the nurses were perfectly distributed to schools with diabetic students, they couldn't possibly tend to them all at once.

Yet most of the children needing insulin injections need them about the same time, around lunchtime. And many students need insulin at other times, sometimes unpredictable, during the day.

In an perfect world, we would have enough school nurses to go around — to help every diabetic student who needs assistance with an injection. But we don't live in an perfect world. Everything has a price. And, in this case, more nurses means fewer teachers. There's no magic here. Right now, there isn't enough money to go around. As it is, the governor and legislators are already talking of raising taxes and slashing programs, including education, to balance the books.

Sometimes, we must accept that we can't have it all — that we can't let the perfect be the enemy of the good.

Most of the medical and disability community was happy with the settlement reached with the state Department of Education that would have allowed trained school employees to assist the diabetic students when nurses weren't available. It's not ideal, but sometimes it's necessary.

Just as it's necessary for parents to administer insulin to their diabetic children at home. Most parents cannot afford a full-time nurse.

Unfortunately, as the judge ruled, state law must be changed to permit school employees other than nurses to administer insulin. And, if the nurses union lobby doesn't back down, that's not likely to happen any time soon. That is, unless parents put up enough of a stink with their legislators.

Borenstein is a staff columnist and editorial writer. Reach him at 925-943-8248 or dborenstein@bayareanewsgroup.com.