Pre-referral guidelines for primary care providers

Type 1 diabetes mellitus (T1DM), formerly insulin dependent diabetes mellitus, is a genetic condition seen in 1 in 500 Australian children and represents a chronic incurable disease that has major implications for ongoing health care. There is a bimodal peak in onset, both at 5-7 years and in adolescence.

Type 2 diabetes mellitus (T2DM), formerly non-insulin dependent diabetes, is increasingly seen in overweight Australian children. This condition should be considered in any overweight child with typical symptoms, although will not be covered further here.

For the management of diabetic ketoacidosis or newly diagnosed mildly ill diabetics, refer to the Royal Children's Hospital clinical practice guidelines.


All new type 1 diabetes (T1DM) diagnoses should be referred for Emergency Department evaluation.

The diagnosis of T1DM can be atypical in children, and must be considered in all age groups. Presenting features, often triggered by intercurrent infection, may include:

  • polyuria and polydipsia
  • lethargy, anorexia, loss of weight
  • abdominal pain +/- vomiting
  • dehydration, altered consciousness, Kussmaul breathing

Children with T1DM often present on diagnosis in diabetic ketoacidosis (DKA). Likely or proven DKA is potentially life-threatening and should be referred immediately to an Emergency Department competent in paediatric care. See the RCH clinical practice guidelines for further detail. Unexplained hyperglycaemia also requires referral to an Emergency Department.

Screening for T1DM can be done with a random blood sugar (> 11 mmol/L), and if unsure, check urine glucose and ketones. Fasting blood sugar can be useful (> 7 mmol/L).

Practice points


Management of all new T1DM should be undertaken in an inpatient setting.

Ongoing management of T1DM should be undertaken by a multidisciplinary treatment team (paediatrician or endocrinologist, diabetic educator, dietitian and social worker) rather than a general practice setting.

Referral pathways

  • Paediatrician
    • Referral to paediatric outpatient services is not appropriate in the management of DKA or for newly diagnosed T1DM. Refer immediately to an Emergency Department.
    • Outpatient management for T1DM is undertaken in either:
  • Allied Health
    • Referrals for allied health support for diabetes can be organized through the above clinics.
    • Several private diabetic services and dietitians exist in Ballarat and can be accessed through the relevant paediatrician coordinating care (see Paediatrics Ballarat).