Diabetes

Who to refer:

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 (days/weeks) and/or
• Ketonuria/ketonaemia

Any existing person with diabetes who is acutely unwell and at risk of DKA

Any pregnant woman with a new diagnosis of Type 1 or Type 2 diabetes

Any suspected limb-threatening or life-threatening diabetes foot problem

• Ulceration with fever or any signs of sepsis
• Ulceration with limb ischaemia
• Clinical concern of deep-seated soft tissue or bone infection
• Gangrene

For Adults Contact on-call Diabetes Registrar for either WGH or RIE via switchboard (0131 536 1000) or SJH by paging Diabetes Specialist Nurses (01506 523 000)

For children (under the age of 16) contact the paediatrics diabetes on-call register at the RHCYP via switchboard (0131 536 1000)

URGENT

• New diagnosis of gestational diabetes in a pregnant woman (usually referred by community midwives through the antenatal pathway)
• Individual with diabetes with a new foot ulcer (who do not have the emergency referral criteria as above)

ROUTINE

• Individuals with established Type 1 diabetes
• Individuals with Type 2 diabetes aged <40 years
• Individuals with Type 2 diabetes not meeting age/frailty-appropriate HbA1c target despite maximal tolerated oral agents and who may require injectable therapy
• Individuals with Type 2 diabetes with chronic complications and suboptimal control
• Individuals with diabetes complications requiring specialist input, e.g. peripheral neuropathy, CKD
• Individuals where the type of diabetes is uncertain
• Individuals with suspected secondary diabetes (e.g. chronic pancreatitis)
• Individuals with suspected/confirmed monogenic diabetes (refer to monogenic diabetes clinic, WGH)
• Women with diabetes planning pregnancy
• Individuals with steroid-induced hyperglycaemia who have suboptimal control on maximum tolerated oral agents (as specified in the steroid therapy management guidelines)

ADVICE only

• Optimisation of non-insulin drug therapies to improve HbA1c

Who not to refer:

• Individuals with Diabetes or Pre-diabetes requiring help with weight loss only:
  • Individuals with Diabetes can be referred (or self-refer) for Tier 2 or Tier 3 weight management, the Counterweight Plus remission programme for Type 2 Diabetes. For further information see (Diabetes Remission – RefHelp (nhslothian.scot))Individuals with Pre-diabetes can be referred for Type 2 Diabetes Prevention and Prediabetes education programme (See Pre-Diabetes – RefHelp (nhslothian.scot))
  • Alternatively, contact weight management team on 0130 537 9169 from Monday-Friday 9-5
• Individuals with Diabetes under age of 16 see Paediatrics Endocrinology (LINK https://apps.nhslothian.scot/refhelp/Paediatric/PaediatricEndocrinology )
• For retinal screening only see Diabetes Retinopathy (link to  https://apps.nhslothian.scot/refhelp/Ophthalmology/DiabeticRetinopathy)

How to refer:

• Emergency referrals phone (see above to phone on call registrar) then complete Urgent SCI gateway referral through RIE/WGH/SJH/RHCYP-Diabetes  
• General referrals:  SCI Gateway through RIE/WGH/SJH/LCTC/RHCYP- diabetes
• Advice only New Referrals: SCI Gateway –RIE/WGH/SJH/ELCH/LCTC-diabetes-advice only
• Advice only existing patients Email:

St Johns Hospital                    Clinadvdiabetes@nhslothian.scot.nhs.uk

Western General Hospital       WGH.DiabeticAdvice@nhslothian.scot.nhs.uk

Royal Infirmary Edinburgh    RIE.DiabeticAdvice@nhslothian.scot.nhs.uk

The Email advice lines are useful for simple queries for patients whom you envisage to continue to manage in primary care. The advice emails are not appropriate for urgent referrals, which should either be sent in via SCI Gateway or discussed with the diabetes registrar on call.

The Email advice lines are not ideal for complex queries where the responding consultant would benefit from full past history and medication list; these patients should still be referred using the Advice Only option on SCI Gateway.

For specialty clinics see referral guidance under each section.

Useful information to include with your referral:

Recent HbA1c

Urinalysis for ketonuria

BMI

Acute diabetic symptoms such as rapid weight loss

Known diabetic complications

Blood pressure

PCR or ACR

Smoking status

Lipid profile