The management of diabetes during the last few weeks of life may pose some problems for
those nursing or caring for people with diabetes. The purpose of this web page is to
give all carers and health professionals information and points to consider that will
enable the patient with diabetes to die with dignity and without suffering the more severe
symptoms of uncontrolled diabetes.
Points To Consider:
What Are The Goals Of Treatment?
To give the appropriate level of support to patients and carers to prevent symptoms of
hypoglycaemia and hyperglycaemia.
Determine What Type of Diabetes the Patient Has
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TYPE 1: Perhaps a change to long acting insulin would be more appropriate at
this time to give a background level of insulin. This would reduce the risks of
hypoglycaemia but also keep symptoms of thirst and polyuria under control.
If the patient is finding it difficult to eat or is refusing to eat, an agreed
plan for care can be discussed in full with the GP or with the Diabetes Care Team.
-
TYPE 2: It may be that patients with type 2 diabetes who are on insulin will no longer
require this. If they can still swallow, oral medication could be given instead.
If the patient is on oral medication but is refusing to eat, or unable to eat,
then consideration may be given to stopping this medication. Again a plan for
care can be fully discussed with the GP or Diabetes Care Team.
Relax
Diet
At this stage it is more important for the patient to have
some nutrition in a form that is acceptable to them rather than keeping to a strict diet.
Blood Glucose Monitoring
This is not the most important part of patient care at this stage.
When patients are in the terminal stages of illness blood glucose monitoring should be more relaxed.
This should be carried out to determine if a patient is hypoglycaemic or, if a patient complains of
the symptoms of hyperglycaemia ie. Polyuria, polydipsia. Once symptoms have subsided then blood
glucose monitoring can be relaxed again.
Remember...
Steroids
These can induce diabetes and affect blood sugar control. Remember doses of diabetes drugs
and insulin may need to be reduced when reducing steroid doses. Can cause candida infections
requiring prompt action with anti-fungal medication.
Weight Loss
If there is marked weight loss NOT due to poorly controlled diabetes, it may be necessary to
consider reducing doses of insulin, oral hypoglycaemics, and antihypertensives.
Renal Failure
If renal failure is present patients may require a reduced dose of insulin, oral hypoglycaemics and opioids.
During Weekday Working Hours
the Diabetes team is available for consultation and advice.
Dundee - 01382 633909
Angus - 01241 430303
Perth - 01738 793476
During Out of Hours
help and advice can be given by your own GP and District Nurse.
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