Referral to emergency

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.

  • hypoglycaemic episode e.g. seizures or reduced cognition

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 - appointment clinically indicated within 30 days

  • hypoglycaemia
  • suspected insulinoma

Category 2 — appointment clinically indicated within 90 days

  • suspected hypoglycaemia

Category 3 — appointment clinically indicated within 365 days

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical history
  • current medications and dosages including access to drugs which may cause hypoglycaemia
  • allergies and sensitivities
  • use/frequency of alcohol, tobacco, and other drugs
  • onset, duration, and progression of symptoms
  • management history including:
    • treatments trialled/implemented prior to referral
    • presence of any complications and details when screening last performed
  • physical examination findings
  • height/weight
  • body mass index (BMI)
  • blood pressure

Pathology

  • when symptomatic, if possible:
    • blood glucose level (BSL)
    • concomitant insulin
    • C-peptide level

Additional information to assist triage categorisation

  • morning cortisol (8.00 am to 9.00 am)
  • adrenocorticotropic hormone (ACTH)

Clinical management advice

True pathological hypoglycaemia is rare in patients who are not severely unwell, or medicated with insulin or sulfonylureas for diabetes mellitus. Ideally, Whipple's triad should be fulfilled, meaning that typical symptoms (either sympathetic or neuroglycopaenic) are present during confirmed low blood glucose (preferably venous), and these symptoms are swiftly alleviated upon glucose administration, leading to blood glucose normalisation.

The most universally informative test entails measuring venous glucose, insulin, and C-peptide levels when symptoms are evident, prior to administering exogenous glucose. Coordinating this process can be challenging and necessitates effective communication with the laboratory, patient, and family members to ensure timely venous sampling.

All venous blood samples for glucose must be collected in fluoride tubes, while insulin and C-peptide samples require plain tubes. Capillary glucose readings often lack accuracy, particularly at lower levels, making them unsuitable for guiding diagnostic and treatment choices

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Investigations not required

The following investigations are not required for assessment of hypoglycaemia:

  • glycated haemoglobin test (HbA1c)
  • oral glucose tolerance test (OGTT)
  • insulin levels, apart from at the time of true hypoglycaemia

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • 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

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.