Quality Standards for Diabetes Care Toolkit

Guidelines

The New Zealand Primary Care Handbook 2012 recommends seeking specialist advice in situations of recurrent hypoglycaemia: www.health.govt.nz/publication/new-zealand-primary-care-handbook-2012.
The Scottish Intercollegiate Guidelines Network (SIGN) guidelines (2010) provide the following recommendations:

Adults with type 1 diabetes experiencing problems with hypoglycaemia or who fail to achieve glycaemia targets should have access to structured education programmes based upon adult learning theories (see Standard 1).

Basal insulin analogues are recommended in adults with type 1 diabetes who are experiencing severe or nocturnal hypoglycaemia and who are using an intensified insulin regimen.

Continuous Subcutaneous Insulin Infusion (CSII) pump therapy should be considered in people who experience recurring episodes of severe hypoglycaemia.

Individualised advice on avoiding hypoglycaemia when exercising by adjustment of carbohydrate intake, reduction of insulin dose, and choice of injection site, should be given to people taking insulin.

People with diabetes and health care professionals should make every effort to avoid severe hypoglycaemia, particularly in those who are newly diagnosed.

Treatment to glycaemia targets increases the incidence of hypoglycaemia. Significantly more episodes were reported in intensive versus conventional therapy groups in most studies, eg, The ACCORD and ADVANCE trial (SIGN, 2010).
The complete guidelines can be found here: www.sign.ac.uk/pdf/sign116.pdf