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.

Diabetes

• New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
• Ketoacidosis in a known diabetic with any of the following:
  • systemic symptoms (fever, lethargy)
  • vomiting
  • inability to eat (even if not vomiting)
  • abdominal pain
  • headache

• 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 DKA and subsequent morbidity and mortality
• In rural and remote areas it is preferable that local health professionals, who have access to the specialist paediatric diabetes team, provide ongoing support and education. If the child/adolescent/family is unable to access these health professionals, support with education should be provided by the experienced health professional at the provincial or tertiary diabetes centre, via videoconference or phone.
• Groups for whom inpatient management is necessary at diagnosis of type I diabetes include:
  • individuals with diabetic ketoacidosis, significant comorbidities, inadequate social support or mental health issues
  • children < 2 years of age
  • those in geographically remote areas
  • non-English speakers
• Refer to local/regional diabetes education/dietetic services. Registration with NDSS (national diabetes services scheme).
• Develop an individualised management plan which includes planned interaction with local caregivers, local health team and visiting specialists where necessary.
• If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: https://www.communities.qld.gov.au/

If your patient does not meet the minimum referral criteria

• Consider other treatment pathways or an alternative diagnosis
• If you still need to refer your patient:
  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Patient's Demographic Details

• Full name (including aliases)
• Date and country of birth
• Residential and postal address including whether patient resides at an aged care facility
• Telephone contact number/s – home, mobile and alternative
• Medicare number (where eligible)
• Name of the parent or caregiver (if appropriate)
• Name of delegate and contact details (Department of Corrective Services)
• Preferred language and interpreter requirements
• Identifies as Aboriginal and/or Torres Strait Islander
• Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

• Full name
• Full address
• Contact details – telephone, fax, email
• Provider number
• Date of referral
• Signature
• Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Relevant clinical information about the condition

• Presenting symptoms (evolution and duration)
• Physical findings
• Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
• All conservative options that have been pursued unsuccessfully prior to referral
• Body mass index (BMI)
• Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
• Any special care requirements where relevant (e.g. tracheostomy in place, oxygen required)
• Current medications and dosages
• Drug allergies
• Alcohol, tobacco and other drugs use

Reason for request

• To establish a diagnosis
• For treatment or intervention
• For advice and management
• For specialist to take over management
• Reassurance for GP/second opinion
• For a specified test/investigation the GP can't order, or the patient can't afford or access
• Reassurance for the patient/family
• For other reason (e.g. rapidly accelerating disease progression)
• Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

• Impact on employment
• Impact on education
• Impact on home
• Impact on activities of daily living functioning – low/medium/high
• Impact on ability to care for others
• Impact on personal frailty or safety
• Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery (where surgery is a likely intervention)
• Choice to be treated as a public or private patient
• Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc

Essential referral information

Without this information the referral will be rejected

• General referral information
• History of the presentation 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 [eg acanthosis nigricans])
• Report presence or absence of Red flags

Presence of Red flags

• Polyuria or polydipsia
• Recent weight loss
• Recent onset enuresis
• Ketosis on urine or blood testing
   

Investigations for suspected type 2 diabetes

• HbA1c FBC U&E LFT CRP TFT results
• Fasting plasma glucose  and lipids results
• Ketones (blood or urine) – If positive send direct to emergency
  
  NB follow up/review patients will have pathology attended to in the clinic, the patient is not required to get blood tests prior to attending on an ongoing referral