Type 1 Diabetes Referral Guidelines

Type 1 diabetes is generally an autoimmune condition when pancreatic islet cells are unable to produce enough insulin to maintain blood sugar within normal range. Without insulin, the body will be unable to metabolize glucose and blood sugars will increase. In order to provide energy, the body will break down fat and protein and may develop ketones, which can cause diabetic ketoacidosis (DKA). Patient symptoms will include increased urination, dehydration, increased drinking fatigue and weight loss.

How should I initially evaluate and manage my patient?

Providers can evaluate patients for Type 1 diabetes with a primary care office setting urinalysis test, looking for a positive reading on glucose and ketones. If possible, providers should obtain a laboratory serum blood glucose level (random).

Initial management of patients can include paging the endocrine physician on-call for evaluation, who will give instructions for further management. In most cases, the patient will be referred to Children's National Emergency Department, where he or she will be evaluated and if the diagnosis is confirmed, begin treatment. The majority of new onset patients will be admitted to the hospital for fluids, insulin initiation and stabilization along with diabetes education. Those with DKA will be rehydrated, receive an IV insulin drip and electrolyte replacement.

When should I refer my patient?

Providers may consider initiating referral to our Endocrinology and Diabetes Program or the Emergency Department when symptoms include:

Increased drinking
Urination
Weight loss
Fatigue along with glucose and or ketones in the urine (and if information available -- elevated serum glucose levels.

A random blood sugar test over 200, along with the above symptoms indicates the likelihood of new onset Type 1 diabetes.

How can I refer my patient?

What can my patient expect from a visit to Children's National Hospital?

In the Emergency Department, the patient will start on IV fluids to be hydrated, receive lab work, consultation with endocrinology and begin insulin therapy if a diagnosis is confirmed.

Once admitted, diabetes education is received from diabetes educators, all prescriptions are ordered and the patient has daily telephone or email follow up until insulin doses are stabilized.

The patient will come back 2-4 weeks later for a second education class. The patient will have a follow-up visit with a diabetes specialist in 2-3 months at our main hospital or one of our outpatient centers.