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Referring Guidelines for Diabetes clinic 707C

Referral
Diagnosis /
Evaluation Management Options Guidelines/Urgency
Symptomatology
Rating

Standard history and 1. All those with Type 1 The following urgency
• Diabetes – Chronic examination. diabetes require rating system has been
and complex insulin. used:
Key points and 2. All CVRF should be
appropriate investigations managed aggressively Urgent
1. All patients with newly – consider ?? statin in all
diagnosed diabetes patients- Aim for BP (a) Patient required to be
and ketonuria should <130/80 seen at next clinic.
be managed as Type 1 Referrer to telephone the
until proved otherwise. For most with diabetes clinic registrar – who will
2. Cardiovascular risk is community care is refer to the diabetes early
high and full appropriate including GP, intervention support clinic
cardiovascular history DNE, dietician and
and investigations podiatrist. In complex (b) Patient required to be
needed. Prevention of cases where care cannot seen at clinic within 2 – 4
microvascular be provided with the weeks. – refer to the
complications requires assistance of a private diabetes early intervention
regular screening. endocrinologist to referral clinic at MMC and
to this multidisciplinary Dandenong Hospital
Investigations: complex service is
HbA1c– 3/12 appropriate. Non urgent
Lipids – annually
Eye review – 1-2 yearly For short term support Patient to be seen at
Podiatry review – regularly with care eg insulin next available appointment
with ‘at risk’ feet stabilisation, challenging – 3-4 months wait.
(neuropathy or vascular BP management etc
disease) patients can be referred to
Microalbumin spot the diabetes support/early
Urine - annually intervention services at
MMC and DDH for shared
care with primary care
GPs.
Diagnosis /
Evaluation Management Options Referral Guidelines
Symptomatology
Diabetes 1. All patients with newly Type 1 diabetes: ‘sick day’ Urgent:
diagnosed diabetes management: Type 1 diabetes:
Classification: and ketonuria should • all newly diagnosed
Type 1 be managed as Type 1 • If vomiting or other patients – urgent call
Type 2 until proved otherwise. acute illness not registrar
requiring immediate • known patients with
Diagnosis: intravenous therapy: acute illness and
fasting plasma glucose • do not omit insulin ketonuria – urgent call
>7.0 mmol/L doses registrar unresponsive
random or 2 hour GTT • frequent (at least four to ‘sick day’
plasma glucose >11.1 times daily) blood procedures → ED
mmol/L glucose tests Type 2 diabetes:
• blood glucometer • acute illness with
Type 1 vs Type 2: ketone tests 4/24 or if volume depletion,
Type 1: ketonuria; unavailable if ketones altered mental state,
detectable islet cell and/or 70.6 refer to ED plasma glucose > 25
GAD antibody, low c- • test each urine mmol/L
peptide, insulin deficient. specimen for ketones Diabetes complications:
• if ketonuria, refer • foot ulceration with
Type 2: no detectable islet urgently to emergency cellulitis, acute
cell or GAD antibody; department neuropathic
elevated or high-normal c- arthropathy – refer to
peptide, insulin resistant. foot service
MMC/DDH
• high risk retinopathy
Pregnancy – refer to
diabetes in pregnancy
service, MMC/DDH

Semi-urgent, routine
(all 707C clinic referral):
• inadequate glycaemic
control
• recurrent
hypoglycaemia
• appearance,
progression of
complications eg
retinopathy,
nephropathy,
neuropathy, foot
ulceration.

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