Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- new diagnosis of diabetes: polyuria and/or polydipsia with random blood glucose of > 11.0 mmol/L
- known youth with diabetes: with elevated ketones > 1.5 and either vomiting, abdominal pain or altered conscious state
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Women's and Children's Health Network
- Women’s and Children’s Hospital (08) 8161 7000
Category 1 - appointment clinically indicated within 30 days
- suspected type 2 diabetes where child/adolescent assessed to be well and without ketosis
- child/adolescent with known unstable type 1 diabetes transferring care
Category 2 — appointment clinically indicated within 90 days
- child/adolescent with known stable type 1 diabetes transferring care
Category 3 — appointment clinically indicated within 365 days
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- past medical/surgical history, including:
- reasons why this is thought to be type 2 diabetes rather than type 1, e.g. strong family history of type 2, obesity, evidence of insulin resistance e.g. acanthosis nigricans
- onset, duration, and progression of symptoms
- report presence or absence of concerning features:
- polyuria or polydipsia
- recent weight loss
- recent onset enuresis
- ketosis on urine or blood testing.
- current medications and dosages
- allergies and sensitivities
- examination results
- height/weight/body mass index (BMI)
- blood pressure
- glycated haemoglobin test (HbA1c)
- random blood glucose level, fasting glucose not required
- ketones (blood or urine), if positive send direct to emergency
Additional information to assist triage categorisation
Highly desirable information – may change triage category
- mode of presentation, whether insidious or acute
- other past medical history
- family history, especially of diabetes, polycystic ovary syndrome (PCOS) and other endocrine conditions
- height/weight/head circumference and growth charts with prior measurements if available
Desirable information - will assist at consultation
- birth history
- immunisation history
- developmental history
- medication history
- significant psychosocial risk factors, especially parents’ mental health, family violence, housing and financial stress, department of child safety involvement
- any other relevant laboratory tests or medical imaging
Clinical management advice
All newly diagnosed/suspected type 1 diabetes must be seen as an emergency as soon as the diagnosis is suspected. Do not wait for test results to become available except near patient testing of blood sugar level.
To avoid delay in diagnosis, physicians need to take due care in their detection of diabetes in a patient and in defining its clinical sub‐type, since delayed diagnosis of type 1 diabetes in a child or adolescent is associated with an increased risk of diabetic ketoacidosis (DKA) and subsequent morbidity and mortality.
Type 1 diabetes can present at any age, but is very rare in children < 6 months. The diagnosis always requires urgent discussion with the Women’s and Children’s Hospital (WCH) Diabetes team or evaluation in WCH Emergency department on the day of diagnosis, as even an apparently well child can deteriorate quickly. There is no need to wait for a fasting blood glucose level (BGL) if a random BGL is elevated.
Type 2 diabetes usually presents in children > 8 years with a family history of type 2 diabetes. It is associated with overweight, acanthosis nigricans and high-risk ethnicities (Aboriginal, Asian, Indian and Hispanic).
Children may have stress hyperglycaemia in conjunction with an intercurrent infection and fever. This always requires assessment to exclude early type 1 diabetes.
The WCH endocrinology service can evaluate children at risk of type 1 and 2 diabetes on the basis of family history as they are the SA Centre for all preclinical intervention trials and studies in childhood and adolescent type 1 diabetes. This includes the Environmental Determinants of Islet Autoimmunity (ENDIA) Study following at risk children from pregnancy. They are also the SA Centre for diabetes technology trials and national and national and international trials to prevent vascular complications in children and adolescents.
Contact WCH endocrinology on-call on (08) 8161 7000 for advice or to escalate and discuss any clinical concerns.
Recent pathology results will be required prior to outpatient appointment. Consider providing repeat pathology form to patient at time of referral.
Patients who have previously been seen by a specialist are encouraged to be referred back to their care for further review if required.
Referrals are accepted at the discretion of the triaging clinician. If you are concerned that your patient requires specialist review, but may not fit the criteria provided, you are encouraged to contact the specialist team to discuss your concerns.
- Therapeutic Guidelines - Type 1 Diabetes in Children and Adolescents
- Therapeutic Guidelines - Type 2 Diabetes in Children and Adolescents
- International Society for Paediatric and Adolescent Diabetes (ISPAD) - Clinical Practice Consensus Guidelines
- ISPAD - Clinical Practice Consensus Guidelines 2018: Stages of type 1 diabetes in children and adolescents (PDF 930KB)
- ISPAD - Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth (PDF 1720KB)
- SA Health - Diabetic Ketoacidosis (DKA) in Children and Adolescents (PDF 625KB)
- Royal Children's Hospital Melbourne - Diabetes Mellitus