Paediatric Diabetes

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment.

Contact through:

Caboolture Hospital (07) 5433 8888
Redcliffe Hospital (07) 3883 7777
Royal Brisbane and Women's Hospital (07) 3646 8111

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

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

Paediatric Diabetes services are delivered on behalf of MNHHS from Caboolture only

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Suspected type 2 diabetes where:
- child/adolescent assessed to be well and without ketosis. Health care provider confident of type 2 diagnosis
Unstable known type I diabetes transferring care
A child currently in out of home care (OOHC), or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service.

Category 2

Appointment within 90 days is desirable

Stable known type 1 diabetic transferring care

Category 3

Appointment within 365 days is desirable

No category 3 criteria

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

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available
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: Department of Children, Youth Justice and Multicultural Affairs
Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

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 [e.g. acanthosis nigricans])
Report presence or absence of concerning features
- Polyuria or polydipsia
- Recent weight loss
- Recent onset enuresis
- Ketosis on urine or blood testing
Confirmation of OOHC (where appropriate)

Pathology and Test Results

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

Additional referral information, Useful for processing the referral

Highly desirable information – may change triage category

Mode of presentation, whether insidious or acute
Other past medical history
Family history, especially of diabetes, Polycystic ovarian syndrome (PCOS) and other endocrine conditions
Height/weight/head circumference and growth charts with prior measurements if available.

Desirable information- will assist at consultation

Pregnancy and birth history
Immunisation history
Developmental history
Medication history
Allergies
Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
Other physical examination findings inclusive of CNS, birth marks or dysmorphology
Any other relevant laboratory results or medical imaging reports

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use