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
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.