Direct to an emergency department for:

  • Diabetic ketoacidosis or suspected diabetic ketoacidosis (e.g. abdominal pain, dehydration, confusion, nausea and vomiting)
  • Hyperosmolar hyperglycemic state
  • Diabetes and severe vomiting
  • Acute, severe hyperglycaemia
  • Acute, severe hypoglycaemia
  • Suspected Charcot’s neuroarthropathy (e.g. unilateral, red, hot, swollen, possibly aching foot)
  • Foot ulceration with absent pulses.

Immediately contact the endocrinology registrar to arrange an urgent endocrinology assessment for:

  • Pregnancy in known diabetic woman
  • Recent, resolved hypoglycaemia episode resulting in unconsciousness.

Criteria for referral to public hospital specialist clinic services

  • Type 2 diabetes not responding to a combination of dietary AND medical management (i.e. has tried at least three glucose-lowering medicines) with HbA1c > 64 mmol/mol or 8%
  • Patients with type 2 diabetes with complications (e.g. cardiovascular disease, kidney disease, retinopathy, cerebral vascular disease, neuropathy)
  • Planning for pregnancy
  • Management of unstable glycaemic control due to concomitant use of medicines that impact on glycaemic control (e.g. corticosteroids, chemotherapy protocols)
  • Assessment for commercial driver’s licence
  • Diagnosis of type of diabetes.

Information to be included in the referral

Information that must be provided

  • Reason for referral.
  • All medicines previously tried, duration of trial and effect
  • Current and previous HbA1c results
  • Known complications or comorbidities (e.g. cardiovascular disease, kidney disease, retinopathy, cerebral vascular disease, nerve damage in the lower limbs, anxiety, depression, foot ulcers)
  • Current and complete medication history (including non-prescription medicines, herbs and supplements)
  • Urea and electrolyte results
  • Creatinine blood results
  • Albumin to creatinine ratio (ACR) urine results
  • Liver function results
  • Lipid profile results.
  • Functional impact of symptoms on daily activities including impact on work, study or carer role
  • If the person identifies as an Aboriginal and Torres Strait Islander
  • If the person is part of a vulnerable population.

Provide if available

Not applicable.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Vulnerable populations include:

  • people from culturally and linguistically diverse backgrounds
  • older Australians
  • carers of people with chronic conditions
  • people experiencing socio-economic disadvantage
  • people living in remote, or rural and regional locations
  • people with a disability
  • people with mental illness
  • people who are, or have been, incarcerated.

Vulnerable patient groups also include: terminally ill patients, patients with experiences of family violence, in out-of-home care, foster care and those in state care.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

  • Well controlled type 2 diabetes (responding to dietary and medical management with HbA1c < 64 mmol/mol or 8%) without any complications or comorbidities
  • Patients being managed with dietary measures alone.