Type 1 diabetes

​​​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Acute, severe diabetes-related end-organ complication (e.g. suspected acute coronary syndrome, cerebrovascular event, infected foot ulcer with systemic features, new vision loss, or renal failure)
  • Clinical features suggesting diabetic ketoacidosis or euglycaemic ketoacidosis (i.e. clinical dehydration, rapid or laboured [Kussmaul] breathing, recurrent vomiting, reduced level of consciousness, or haemodynamically compromised with tachycardia or hypotension)
  • Diabetes-related foot ulceration with absent pulses
    Note: refer to a vascular surgeon or high-risk foot service
  • Diabetes-related foot ulceration with features of severe or systemic infection
    Note: refer immediately to emergency department and/or high-risk foot service
  • High ketones unresponsive to initial management (i.e. moderate or greater result on urine testing or > 1.5 mmol/L on finger prick blood test)
  • New diagnosis of type 1 diabetes suspected with clinical instability (e.g. rapid weight loss, polyuria, polydipsia and blood glucose > 15.0 mmol/L)
  • Pre-existing type 1 diabetes with new onset, persistent hyperglycaemia and clinically unwell (i.e. blood glucose level > 15.0 mmol/L for > 4 hours)
  • Pregnant patient with persistent blood glucose level of > 10.0 mmol/L and/or blood ketones > 0.6 mmol/L unresponsive to initial management
  • Pregnant patient with persistent blood glucose level of < 3.5 mmol/L (confirmed by finger prick test, where possible) unresponsive to initial management
  • Recurrent, persistent vomiting for > 4 hours preventing oral intake and hydration
  • Severe hypoglycaemia requiring third party assistance including that occurring with loss of consciousness
    Note: referral to endocrinologist or diabetes service is indicated for rapid access outpatient appointment within 24 hours. If no medical-led specialist outpatient service is available, present to an emergency department.
  • Suspected or diagnosed active Charcot neuro-osteo-arthropathy (i.e. clinical signs of inflammation, particularly redness, heat and/or swelling, in the neuropathic foot)
    Note: same-day referral to a high-risk foot service (or similar service to manage Charcot foot)

When public outpatient services are not routinely provided

  • Private driver's licence holders who require a new or renewed conditional licence
    Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input
  • Routine podiatry care, including annual diabetes-related neurovascular foot assessment​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.
  • For review following severe hypoglycaemia event
    that requires third party assistance or increased hypoglycaemic events
  • Post-diabetic ketoacidosis admission
  • Newly diagnosed type 1 diabetes or suspected type 1 diabetes with clinical stability
  • New diabetes-related foot ulcer
    Note: refer to a podiatrist and/or high-risk foot service
  • Pregnant patient with existing type 1 diabetes
    Note: for optimum care, patient should be seen within 1 week
  • Significant hyperglycaemia despite escalation in therapy with any of the following features:
    • HbA1c > 12.0% (108 mmol/mol)
    • Average blood glucose level of 14.0 mmol/L
  • Type 1 diabetes commencing steroid therapy in the context of new chemotherapy or new pulse steroids for autoimmune or inflammatory conditions
​Category 2
Recommended to be seen within 90 calendar days.

  • Diagnosed type 1 diabetes with Aboriginal and/or Torres Islander descent
  • For consideration to commence continuous glucose monitoring
  • For pre-conception planning
    Notes:
    1. especially if intention for pregnancy within the next 12 months
    2. if pre-existing complications related to their type 1 diabetes, earlier assessment may be indicated
  • Hyperglycaemia despite escalation of therapy with any of the following features:
    • HbA1c > 10.0% (> 86 mmol/mol)
    • Average blood glucose level of 10.0-14.0 mmol/L
  • Type 1 diabetes in the presence of uncontrolled risk factors for cardiovascular disease despite optimal treatment
  • Type 1 diabetes with suspected or known disordered eating
    Note: consider body image concerns with frequent diabetic ketoacidosis or high HbA1c
  • Type 1 diabetes with newly diagnosed coeliac disease
  • Type 1 diabetes with advanced comorbidities or complications that may impact on insulin requirements or not otherwise specified in Category 1
  • Type 1 diabetes requiring optimisation in the presence of severe macrovascular and/or microvascular complications, including, but not limited to:
    • Stage 3 or greater chronic kidney disease
    • Pre-proliferative or proliferative retinopathy or maculopathy
    • New onset or worsening peripheral neuropathy
    • Autonomic complications (e.g. gastroparesis)
    • Recent acute coronary or cerebrovascular   syndrome
  • Type 1 diabetes in a priority population or vulnerable group (e.g. at-risk of homelessness, and/or living with a disability impacting diabetes management)​​

Category 3
Recommended to be seen within 365 calendar days.

  • For consideration to commence continuous subcutaneous insulin infusion pump therapy
  • Young people transitioning from paediatric to adult care
  • Type 1 diabetes not otherwise specified in Category 1 or 2 for reasons including, but are not limited to, any of the following features:
  • HbA1c 8.0-10.0% (64-86 mmol/mol)
  • Ongoing type 1 diabetes management
  • Multi-disciplinary type 1 diabetes education

Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration, and date of diabetes diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Any diabetes complications (e.g. severe hypoglycaemia events or diabetic ketoacidosis, cardiovascular disease, kidney disease, retinopathy, cerebral vascular disease, foot disease, neuropathy, anxiety, depression)
    • Results of complications screening
    • HbA1c level within the last 3 months
    • Height, weight and body mass index (BMI)
    • Blood pressure trends
    • Most recent laboratory measures (preferably within the last 6 months):
      • Full blood count (FBC)
      • Electrolytes, urea and creatinine (EUC)
      • Liver function tests (LFTs)
      • Lipids (total cholesterol, LDL-C, HDL, triglycerides)
      • Urinary albumin: creatinine ratio​

If available

  • Details of relevant medical management (including the course and outcome of treatment)
  • Private driver's licence holders who require routine medical assessment for a new or renewed conditional licence
  • Commercial driver's licence holders who require routine medical assessment for a new or renewed conditional licence
    Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input
  • Previous HbA1c results and diabetes complications screening in younger years
  • Medication history (including non-prescription medicines, herbs and supplements)
  • Past surgical and cancer history, including if osteoporosis is present
  • Physical examination findings
  • Coeliac disease screen
  • Thyroid function tests 
  • Serum antibodies to glutamic acid decarboxylase (anti-GAD) and insulinoma-associated protein-2 (IA2) and ZnT8 antibody
  • Paired c-peptide and blood glucose
  • Ferritin or iron studies
  • Results of depression screening (PHQ-2)
  • Level of diabetes distress (e.g. PAID questionnaire)
  • Blood vitamin B12 level (if peripheral neuropathy is present)​

​Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team. 

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing