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.
- hypoglycaemic episode e.g. seizures or reduced cognition
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Northern Adelaide Local Health Network
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
Category 1 - appointment clinically indicated within 30 days
- suspected insulinoma
Category 2 — appointment clinically indicated within 90 days
- suspected hypoglycaemia
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
- current medications and dosages including access to drugs which may cause hypoglycaemia
- allergies and sensitivities
- use/frequency of alcohol, tobacco, and other drugs
- onset, duration, and progression of symptoms
- management history including:
- treatments trialled/implemented prior to referral
- presence of any complications and details when screening last performed
- physical examination findings
- body mass index (BMI)
- blood pressure
- when symptomatic, if possible:
- blood glucose level (BSL)
- concomitant insulin
- C-peptide level
Additional information to assist triage categorisation
- morning cortisol (8.00 am to 9.00 am)
- adrenocorticotropic hormone (ACTH)
Clinical management advice
True pathological hypoglycaemia is rare in patients who are not severely unwell, or medicated with insulin or sulfonylureas for diabetes mellitus. Ideally, Whipple's triad should be fulfilled, meaning that typical symptoms (either sympathetic or neuroglycopaenic) are present during confirmed low blood glucose (preferably venous), and these symptoms are swiftly alleviated upon glucose administration, leading to blood glucose normalisation.
The most universally informative test entails measuring venous glucose, insulin, and C-peptide levels when symptoms are evident, prior to administering exogenous glucose. Coordinating this process can be challenging and necessitates effective communication with the laboratory, patient, and family members to ensure timely venous sampling.
All venous blood samples for glucose must be collected in fluoride tubes, while insulin and C-peptide samples require plain tubes. Capillary glucose readings often lack accuracy, particularly at lower levels, making them unsuitable for guiding diagnostic and treatment choices
Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.
Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.
Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.
Investigations not required
The following investigations are not required for assessment of hypoglycaemia:
- glycated haemoglobin test (HbA1c)
- oral glucose tolerance test (OGTT)
- insulin levels, apart from at the time of true hypoglycaemia
- The Journal of Clinical Endocrinology & Metabolism - Evaluation and Management of Adult Hypoglycaemic Disorders