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Recognising When to Refer During Diabetes Reviews

A red flag next to a medication bottle and syringe

Pharmacists play a pivotal role in diabetes management, particularly in monitoring and identifying urgent health issues during patient reviews. This article highlights the critical red flags that all pharmacists should be aware of when conducting diabetes reviews, ensuring that urgent cases are referred appropriately.

Diabetic Ketoacidosis (DKA)

DKA is a severe complication primarily seen in type 1 diabetes, characterised by symptoms such as extreme thirst, nausea, and confusion. It’s crucial that pharmacists direct any suspected or confirmed cases of DKA to A&E immediately.


Characterised by low blood glucose levels, symptoms of hypoglycaemia include shaking, sweating, and a rapid heartbeat. Severe cases that are not manageable in primary care should be promptly directed to A&E in order to prevent serious complications such as seizures and potential loss of consciousness.

Vision Threats

Pharmacists should promptly refer patients for an urgent evaluation by an ophthalmologist if they report sudden vision loss, spot new floaters or shadows (which may suggest retinal detachment), or exhibit signs of severe diabetic retinopathy, such as pre-retinal haemorrhage. Early intervention is crucial to prevent permanent damage and manage any serious underlying conditions.

Foot Ulcers

Pharmacists should immediately refer patients with foot ulcers, particularly those at risk of severe infection or gangrene, to acute services. These conditions can lead to significant complications, including amputation, if not promptly addressed. Prompt intervention is vital to prevent severe outcomes and manage the condition effectively.

In Summary

Pharmacists are integral to diabetes care, ensuring that patients receive timely interventions for serious complications. By identifying these red flags and acting quickly, pharmacists can significantly improve patient outcomes and prevent life-threatening emergencies.

If you are interested in learning more, you can access our comprehensive training programme on Diabetes reviews on our academy website here.


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