Referral guideline – Diabetes

Introduction

Type of diabetes

Type 1 diabetes (“Insulin Dependent Diabetes”) remains overwhelmingly the commonest form of the disease by at least 100 fold.

Type 2 diabetes, although a serious condition when it present in the teenager is still very rare and occurs on the background of a family history of type 2 diabetes, is commoner in some ethnic groups and accompanied by usually severe obesity with darkening of the skin of the neck and axillae (acanthosis).

There are also very rare monogenic forms of diabetes and diabetes seen in association with other chronic disorders such as cystic fibrosis.

Type 1 diabetes

Type 1 diabetes is a polygenic disorder sometimes associated with auto-immune disease in the family. Its incidence is rising across the world for as yet undetermined environmental reasons and can occur at any age, though there are pre-school and teenage peaks of presentation.

Presenting features are the classic triad of polyuria, polydipsia and weight loss accompanied by excessive tiredness. Sometimes skin infections or thrush also occur at presentation. Secondary enuresis is a “Red Flag” sign.

There may be abdominal pain, vomiting, altered consciousness and deep breathing – signs of Diabetic Ketoacidosis (DKA). DKA requires immediate admission to paediatric intensive care for intravenous treatment.

Newly presenting Type 1 diabetes should be viewed as a medical emergency as DKA can rapidly supervene and children may die or suffer serious morbidity if diagnosis is delayed.

GP management

  • All children with suspected diabetes should be assumed to have type 1 diabetes.
  • There is NO place for diagnostic testing before referral – all children MUST be seen on the day of presentation via the local ED service, please do not refer through the OPD booking system.

When to refer

  • Any suspicion of diabetes in a patient less than 18 years of age.

Essential referral info

  • Family history of any autoimmune disorders, including diabetes of any type
  • Height/Weight or BMI, if type 2 diabetes suspected
  • Patient details
  • Medicare number
  • Parent/carer name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

Helpful referral info

  • Social history and family structure

Parent service

Diabetes

Contact details

Hospital Switchboard
(Ask for the endocrinology fellow or registrar)
t: 07 3068 1111

Resources

Diabetes Queensland
Australasian Paediatric Endocrine Group (APEG)