Always refer

• Diabetic ketoacidosis/hyperosmolar/hyperglycaemic state
• Severe hypoglycaemia
• Newly diagnosed type 1 diabetes
• Started on insulin as inpatient
• IV insulin infusion for >24 hr
• Parenteral or enteral nutrition
• Foot ulceration
• Persistent hyperglycaemia (>12 mmol/L)
• Recurrent hypoglycaemic episodes
• Unstable/erratic blood glucose
• Patients on GLP analogues (exenatide, liraglutide)

Referral may be required

• Acute coronary syndrome
• Admission for urgent or major elective surgery
• Significant educational need [poor self-management skills (e.g. injection technique, hypoglycaemia management)]
• Newly diagnosed type 2 diabetes
• Poor wound healing
• Corticosteroid therapy
• Patient prescribed insulin or oral hypoglycaemic medication but nil-by-mouth >24 hr
• Patient request

Referral not normally required

• Minor episodes of hypoglycaemia self-treated by patient
• Simple educational need
• Routine dietetic advice
• Well-controlled diabetes
• Good self-management skills
• Routine diabetes care – dietary advice and life-style modification