Guidelines for referral to specialist services
Emergency
-
Protracted vomiting /dehydration/drowsiness ? admit
-
Diabetic foot - if cellulitis, abcess, wet gangrene ? admit/same day referral
Urgent (phone or fax within 24h)
-
Newly diagnosed child ? same day referral to paediatric on call team at WWGH
-
Newly diagnosed patient if clearly unwell, or ketonuria++ or more ? telephone referral to Diabetes Centre at PPH or WWGH within 24h ? contact on call medical team at weekend
-
Pregnant women ?refer to antenatal clinic to be seen within one week ? telephone Diabetes Centre at PPH or WWGH
-
Other newly diagnosed patients with Type 1 diabetes ? refer to one of the Diabetes Centres within 48h
Routine
- Refer to hospital consultant/specialist service
| Condition | Clinic | |
Blood pressure |
• BP>150 systolic or >90 diastolic despite 3 or more agents |
Diabetic clinic |
Glucose |
• HbA1>8% on maximal therapy where good glucose control appropriate target • Hypoglycaemic unawareness |
Diabetic clinic |
Lipids |
• Cholesterol level above target or triglyceride >10mmol/l despite maximal lipid lowering drugs |
Diabetes or lipid clinics |
Young people |
• <16 years • 16-25 years |
Singleton or WWGH paediatric diabetes service Young People's Clinic |
Elderly |
• >65 years if cognitive impairment/significant co-morbidities |
PPH or WWGH geriatric service |
Diabetic foot |
• newly diagnosed • diabetic foot ulcer • high risk feet for assessment • re-ordering of special footwear |
community podiatrist Foot ulcer clinic High risk foot assessment clinic Orthotist |
Neuropathies |
• painful peripheral neuropathy • suspected amyotrophy or diabetic mononeuropathy |
Diabetes
Diabetes |
Peripheral vascular disease |
• severe claudication, ischaemic rest pain |
Vascular surgeon |
Erectile dysfunction |
• if sildenafil unsuccessful |
Urologist |
Renal |
• Persistent microscopic haematuria in the absence of demonstrable urinary infection • Hypertension which is proving particularly difficult to control in the presence of microalbuminuria or diabetic nephropathy • Proteinuria in the nephrotic range, manifest as either >3g/24h or hypoalbuminaemia • Serum creatinine >250 micromol/l regardless of calculated GFR (see below) • Reduction in calculated GFR (see below) of >15ml/min when started on an ACE inhibitor • Progressive deterioration in calculated GFR of >15ml/min per annum • Calculated GFR of below 40ml/min • GFR calculation - The Cockroft-Gault method uses serum creatinine, age, gender and weight to calculate creatinine clearance. It can be easily accessed on www.nephron.com |
Renal Diabetes or renal Renal Renal Renal Renal Renal Renal |
Eyes |
• sudden visual loss • gradual visual loss • suspicion of sight threatening diabetic retinopathy |
A&E department Optometrist Diabetes |
Ischaemic heart disease |
• see local NSF guidelines |
Cardiologist |
Cerebrovascular disease |
• new TIA's/CVA |
Stroke physician or on call physicians |
Psychological problems |
• distress associated with the diagnosis of diabetes • distress associated with the fear of complications • needle phobia, frequent hospital admissions related to diabetes self management |
Diabetes
Diabetes
Diabetes |
Pre-pregnancy counselling |
|
DNS |