1. Established Type 2 Diabetes Mellitus
GP / Practice nurse to refer to Community DSN if:
1) HBA1c > 64 mmol/mol (8.5%) and patient:
on max oral therapy
not tolerating oral therapy
needs insulin review / initiation of insulin OR
2) Patients experiencing regular hypoglycaemia with evidence of blood glucose monitoring
First DSN appointment:
Exploration / assessment
Request blood tests as needed (incl. HbA1c)
Goal setting
Discuss hypoglycaemia (and driving as appropriate) if taking insulin/SUs
Ensure referred to retinal screening
Preconception planning as appropriate – SAFER leaflet
Offer psychology referral
as required
Refer to
Diabetes Specialist Dietitian
Follow-up appointments with DSN:
Review glucose levels
Review blood results
Review/titrate medication
Discuss complications
Discuss injectable therapy if HBA1c target not achieved on max oral agents
Discuss hypoglycaemia/hyperglycaemia
Carbohydrate awareness
Weight management
Dietary advice
Goal setting
Hypoglycaemia
Refer to
Structured Education:
- EDDI (for new DM diagnosis)
- X-PERT (>6 months after diagnosis)
- X-PERT Insulin
- Choose to Lose
For Problematic Type 2 DM:
e.g.
Diabetic control not optimised
Persistent hypoglycaemia
Erratic blood glucose levels
Consider referral to Diabetologist