Diabetes referral guidance

Emergencies

Any possible new diagnosis of Type 1 Diabetes:

• Age <18 years and/or
• Clinically unwell and/or
• Weight loss and/or
• Rapid onset symptoms over days or weeks and/or
• Ketonuria / ketonaemia.

Adults: contact the on-call Diabetes & Endocrinology phone on ext 32186, 09:00-16:30 Monday to Friday. Outwith these times, contact Acute Medicine in the usual way.

Children under 16: contact the Paediatrics Team in the usual way.

Urgent

SCI-Gateway referral

• Any pregnant woman with a new diagnosis of Type 1 or Type 2 Diabetes.
  • Make an urgent SCI Gateway referral
  • Commence 5 mg folic acid
  • Stop medications contraindicated in pregnancy
• New diagnosis of gestational diabetes in a pregnant woman (usually referred by community midwives through the antenatal pathway).

Diabetes triage helpline

The Diabetes triage helpline is available on 01387 244 214 Monday to Friday 9am - 3.30pm for:

• Sick day guidance to people with type 1 diabetes with intercurrent illness who have been assessed by their primary care team and deemed well enough to be managed at home.
• Individuals with Steroid Induced Hyperglycaemia who have suboptimal management on maximum tolerated oral agents, (as specified in local steroid therapy management guidelines)

Routine

• Individuals with established Type 1 Diabetes all have access to Annual Screening and Patient Initiated Follow Up to arrange their own appointments by calling 0345 602 2812. The service will endeavour to see them within 4 weeks of their call.
• Individuals with newly diagnosed Type 2 Diabetes aged <35 years.
• Individuals with Type 2 Diabetes not meeting age / frailty appropriate HbA1c target despite maximal tolerated oral agents (Metformin, SGLT-2 and oral GLP-1) and who may require injectable therapy.
• Individuals with diabetes complications requiring specialist input, e.g. peripheral neuropathy or CKD.
• Individuals where the type of diabetes is uncertain.
• Individuals with suspected secondary diabetes, e.g. chronic pancreatitis.
• Individuals with suspected / confirmed monogenic diabetes.
• Women with Type 1 or Type 2 Diabetes planning pregnancy.
• Individuals with steroid induced hyperglycaemia who have suboptimal management on maximum tolerated oral agents, as specified in local steroid therapy management guidelines.