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 NICE CKS,NICE CKS,NICE CKS,NICE CKS,NICE NG17,NICE NG18.