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13.4. Referral criteria to medical consultation
The situations when the patient is to be referred to medical consultation are to be
determined between the physician and the nursing professional. The following
situations can arise:
• Three succeeding blood glucose between 200-300 mg/dl or one of >300
mg/dl, or ketosis or any incurrent process.
• Frequent hypoglycaemia events.
• Adverse effects to drugs or drug interactions.
• Every six moths or every year, depending on the protocol and the organization
of the health centre, request an analytical check-up, an ECG, or an
ocular fundus check.
Expert
opinion
4
13.5. Referral criteria to specialized care
The consultation criteria with other specialized levels must maintain permanent
contact with the diabetic patient. Training the different teams, the resources available
in each health centre and the existence of protocols in combination with the
specialized levels are to be taken into consideration. In general terms, the following
criteria can be established:
Expert
opinion
4
Endocrinology
• Suspicion of specific DM (genetic, exocrine pancreas diseases and endocrinopathies).
• Pregnancy in a diabetic patient.
• Any diabetic person with poor chronic metabolic control despite therapeutic
modifications.
• Patient under 40 with possible DM 1 when diagnosed.
Nephrology
• Persistent clinical proteinuria (>200 mcg/min or 300 mg/day).
• Creatinine >2 mg/dl or creatinine clearance