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australia clinical guidance

Type 1 diabetes (adults)

Current Australian sick-day, insulin-pump, CGM and driving safety guidance for type 1 diabetes, explicitly not a replacement for the outdated comprehensive 2011 CPG.

JurisdictionAustralia
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceHealthcare professionals practising in Australia
This is an iatroX educational summary of named Australia sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use local diabetes-team access, hospital sick-day protocol and state or territory driver-licensing implementation. Pediatric, pregnancy and routine long-term care require their own current specialist pathway.

Scope

Adults with established type 1 diabetes during intercurrent illness or using insulin-pump and continuous-glucose-monitoring technology, plus driving safety. The sources are current NDSS/ADEA 2025 clinical guides and Austroads. They do not constitute a new comprehensive national type 1 diabetes CPG for diagnosis, routine glycaemic targets, complication surveillance, pregnancy or pediatric care, all of which require specialist and population-specific guidance.
sources for this section:NDSS/ADEA sick-day guidanceNDSS/ADEA pump and CGM guideAustroads fitness to drive

The Bottom Line

  • Treat insulin as essential therapy and ensure every person has an individualized written sick-day plan describing glucose and ketone monitoring, hydration, carbohydrate, insulin adjustment and when to seek urgent help.
  • During illness, continue background insulin unless a diabetes specialist gives a specific alternative, monitor more frequently and escalate when ketones, vomiting or glucose cannot be managed safely at home.
  • For pump users, confirm infusion-site and delivery integrity, supplies and an injectable-insulin backup plan because interruption of rapid-acting insulin can lead to ketosis quickly.
  • Use CGM trends and alerts as part of a clinical plan while retaining access to capillary testing when symptoms and sensor values disagree, readings change rapidly or device failure is suspected.
  • Apply the current Austroads diabetes standard before driving, including glucose monitoring, hypoglycaemia awareness and temporary cessation after a severe event or when safe control is uncertain.
sources for this section:NDSS/ADEA sick-day guidanceNDSS/ADEA pump and CGM guideAustroads fitness to drive

Practical clinical workflow

1
At routine review, verify the written sick-day plan, current insulin delivery, glucose and ketone equipment, in-date supplies, glucagon access, emergency contacts and the person鈥檚 ability to apply the plan.
2
When illness occurs, assess cause and severity, intake, hydration, vomiting, glucose trend, blood or urine ketones, insulin already given and pump or sensor function and identify pregnancy or major comorbidity.
3
Follow the current NDSS/ADEA guide for individualized insulin, carbohydrate and fluid decisions and seek the diabetes team early when readings worsen, the plan is unclear or the person cannot self-manage.
4
For technology, document settings and competency within scope, inspect device and infusion factors, maintain a manual backup and ensure data sharing and alerts support rather than replace clinical judgement.
5
After severe hypoglycaemia, ketosis, device failure or admission, review the precipitant, update the written plan and supplies and reconsider driving and follow-up with the diabetes team.
sources for this section:NDSS/ADEA sick-day guidanceNDSS/ADEA pump and CGM guideAustroads fitness to drive

Safety boundaries and escalation

  • Ketones with vomiting, abdominal pain, deep or laboured breathing, dehydration, drowsiness or inability to keep fluids down suggests diabetic ketoacidosis and requires emergency hospital assessment.
  • Severe hypoglycaemia, seizure, loss of consciousness or repeated low glucose requires immediate treatment and medical review, with no driving until the Austroads criteria are met.
  • Never rely on a failed pump or implausible CGM value without a backup glucose check and insulin-delivery plan; delayed recognition of interrupted basal delivery can be dangerous.
  • Children, pregnancy, eating-disorder-related insulin omission and recurrent ketoacidosis require specialist multidisciplinary pathways outside the scope of these adult sick-day and technology guides.
sources for this section:NDSS/ADEA sick-day guidanceNDSS/ADEA pump and CGM guideAustroads fitness to drive

Implementation

NDSS is an Australian Government initiative administered by Diabetes Australia, and the clinical guides were developed with ADEA. Austroads is national but licensing action is jurisdictional.
sources for this section:NDSS/ADEA sick-day guidanceNDSS/ADEA pump and CGM guideAustroads fitness to drive

Clinical use boundary

This independently written summary is not an official guideline. Check the linked source version, current TGA-approved product information where medicines are involved, and the applicable state, territory and local pathway at the point of care.

sources for this section:NDSS/ADEA sick-day guidanceNDSS/ADEA pump and CGM guideAustroads fitness to drive

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. National Diabetes Services Scheme and Australian Diabetes Educators AssociationClinical guiding principles for sick day management of adults with type 1 diabetes or type 2 diabetesVersion 4.1.0, June 2025; 2024 evidence and expert update funded through the NDSS 路 accessed 2026-08-20
    view source
  2. National Diabetes Services Scheme and Australian Diabetes Educators AssociationManagement of Insulin Pump Therapy and Continuous Glucose MonitoringVersion 3.1, April 2025; first published 2016 路 accessed 2026-08-20
    view source
  3. Austroads and National Transport CommissionAssessing Fitness to Drive for commercial and private vehicle driversAP-G56-22; ISBN 978-1-922700-21-6 路 Edition 6.0, 2022 路 accessed 2026-08-20
    view source
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