What criteria should I use to decide whether to refer a patient with recurrent hypoglycaemia to a specialist?

Refer a patient with recurrent hypoglycaemia to a specialist if they experience recurrent severe hypoglycaemia that has not responded to other treatments. This includes patients with impaired awareness of hypoglycaemia associated with recurrent severe episodes despite education and optimisation of insulin regimens. Consider referral particularly for adults with type 1 diabetes who have recurrent severe hypoglycaemia or impaired hypoglycaemia awareness that persists after structured education and treatment adjustments. For children and young people with frequent hypoglycaemia or recurrent seizures, referral to specialist paediatric diabetes teams is recommended. Additionally, consider referral if there are suspected comorbidities affecting glucose control, such as Addison's disease, coeliac disease, or other organic causes. Referral may also be appropriate for assessment for advanced therapies such as islet or pancreas transplantation in adults with type 1 diabetes and problematic recurrent severe hypoglycaemia.

Key criteria for referral include:

• Recurrent severe hypoglycaemia unresponsive to standard management.
• Impaired awareness of hypoglycaemia with recurrent severe episodes despite education and insulin regimen review.
• Children and young people with frequent hypoglycaemia or recurrent seizures.
• Suspected organic causes or comorbidities complicating glucose control.
• Consideration for advanced therapies (e.g., islet or pancreas transplantation) in adults with type 1 diabetes.

Referral should be to specialist diabetes teams or centres with expertise in managing complex hypoglycaemia cases.