When should I consider referring a patient with hypoglycaemia to a specialist for further evaluation?

Consider referring a patient with hypoglycaemia to a specialist for further evaluation in the following situations:

• If hypoglycaemia becomes unusually problematic or of increased frequency despite standard management, consider referral for review of insulin regimen and contributory factors.
• Refer patients with recurrent severe hypoglycaemia that has not responded to other treatments to a specialist centre, including those assessing for islet and/or pancreas transplantation.
• In adults with type 1 diabetes and impaired hypoglycaemia awareness associated with recurrent severe hypoglycaemia despite structured education and optimized management, consider specialist referral.
• Consider referral to a diabetes specialist team for review of insulin regimen in people with type 2 diabetes who have troublesome or frequent hypoglycaemia.
• Refer patients with suspected organic causes of hypoglycaemia (such as hyperthyroidism, coeliac disease, Addison's disease, chronic kidney disease, or gastroparesis) for further evaluation.
• Refer patients with psychological problems affecting diabetes management (anxiety, depression, eating disorders, behavioural disorders) to appropriate mental health professionals.
• In children and young people with frequent hypoglycaemia or recurrent seizures, consider referral for assessment of cognitive function.

Additionally, review and reinforce patient education on hypoglycaemia awareness and management, self-monitoring, and lifestyle factors before or alongside referral.

Summary: Referral is indicated when hypoglycaemia is recurrent, severe, unexplained by usual factors, associated with impaired awareness, or linked to comorbidities or psychosocial issues requiring specialist input ¹,²,³,⁴,⁵,⁶.