Type 2 diabetes complex escalation referral checklist

Urgency tier

• Immediate treatment and emergency assessment for severe hypoglycemia with impaired consciousness, or suspected ketoacidosis/hyperosmolar crisis; do not wait for the referral packet.
• Prompt clinical review for recurrent hypoglycemia or symptomatic hyperglycemia in an otherwise stable person.
• Expedited referral for persistent poor control despite sequential evidence-based therapy steps.
• Routine referral for optimization of complex regimens or difficult treatment decisions.

Minimum pre-referral workup

• Include latest A1C trend, home glucose patterns, and hypoglycemia episodes.
• Summarize medication trials, dose changes, intolerance, and adherence barriers.
• Provide renal function, urine ACR, blood pressure, weight trend, and cardiovascular comorbidity context.

Referral packet checklist

• Current medication list including non-diabetes agents that influence glycemia.
• Relevant lab/imaging data with dates.
• Clear target question (insulin strategy, cardiorenal optimization, diagnostic uncertainty).

Pre-referral optimization tasks

• Reinforce sick-day and hypoglycemia action plans.
• Ensure interim follow-up interval while awaiting specialist review.
• Share patient goals and barriers to support practical treatment planning.

References

• Diabetes Canada Clinical Practice Guidelines (opens in a new tab)

Something out of date or unclear? Suggest an update. Leave out any patient details.