Management of Diabetes Mellitus (DM) as a Palliative Approach to Care.

Special Considerations at End of Life

  • Common symptoms at EOL, such as poor appetite, reduced intake and nausea/vomiting may increase risk of hypoglycemia.
  • Metabolic disturbances, such as cachexia, may make tight blood glucose (BG) control difficult.
  • Both diabetic and non-diabetic patients being treated with steroids may experience hyperglycemia as a side effect of treatment.

Revisiting Goals of Care When Life Expectancy is Limited

  • Tight control of BG levels aimed at reducing long-term complications of DM are no longer necessary.
  • Goals may now include (according to patients’ wishes):
    • Less frequent BG monitoring and insulin injections.
    • Decreased pill burden.
    • Preventing symptoms of hyperglycemia that impact quality of life.
    • Preventing episodes of hypoglycemia that expose the patient to risk of coma and hypoglycemia-related death.

Revising Treatment Plan Accordingly

  • All treatment decisions should be individualized and in keeping with the patients’ goals of care. Whether the patient has Type 1 or Type 2 DM will guide the treatment plan.
  • Newer guidelines suggest that interventions might include:
    • Type 1: Consider ongoing insulin treatment at a lower dose if BG levels are high enough to cause symptoms. Individualized Short-Acting insulin sliding scales on a PRN basis may be helpful.
    • Type 2: Reducing or stopping hypoglycemic treatments and BG monitoring unless symptomatic hyperglycemia is suspected.
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PDF – Tip_Oct2017_ManagingDiabetes_Palliative Approach

Source: Pallium Canada (2016) The pallium palliative pocketbook.