In terminal illness careful control to avoid long-term complications is not required. Management of diabetes during terminal illness will not only depend on the type of diabetes, but also on prognosis, oral intake and the presence of co-existing disease such as renal and hepatic impairment. All dietary restrictions relating to diabetes are removed from the early stage of terminal illness. In both T1DM and T2DM, glucose monitoring should be reduced to an acceptable minimum. In the case of a patient treated with insulin, this may be 2–3 times per week and for a patient treated with oral agent’s blood glucose could be monitored 1–2 times per week., only in case of special situation frequent monitoring is advisable. This may include: hypoglycaemia, poor food intake, nausea and vomiting, enteral or parenteral feeding or corticosteroid use. The clear aim is to avoid hypoglycaemia and osmotic symptoms, so the recommendations suggest a target blood glucose range between 10 and 15 mmol/l in the early stage of terminal illness with a more liberal range of 5–20 mmol/l in the later stages. Subsequently there are no agreed, evidence-based strategies to manage diabetes at the end of life or during terminal illness. Therefore, in this review I will try to uncover some of the challenges and discuss the available guidelines associated with managing diabetes at the end of life and terminal illness from the available scientific evidence.

Diabetes is a well-known cardiovascular risk factor in both T1DM and T2DM. They have a 4-10 higher risk of developing complications from CVD than the non-diabetic population. The importance of intensive glycaemic control to prevent CVD in T1DM was established in both “The Diabetes Control and Complication Trial” (DCCT) and “Epidemiology of Diabetes Intervention and Complications” (EDIC) trials. Despite the epidemiological evidence that poor glycaemic control can lead to higher incidence of cardiovascular events in T2DM, the intervention trials are still inconclusive. In this report we will highlight the pathophysiology of the effect of hyperglycemia on the cardiovascular system, the effect of medications, and the major Randomized Control Trials (RCTs) looking specifically at the cardiovascular outcome of intensive glycaemic control in T2DM. Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 50-56

A 61-year-old man known to have metastatic prostate adenocarcinoma was seen at Changi General Hospital, Singapore, because of severe hypokalaemia due to ACTH dependent Cushing’s syndrome. He underwent a Dotate PET CT which showed increased DOTA-NOC-avidity in the right side of the prostate gland. Subsequent immunohistochemical staining of prostate biopsy sample documented ACTH, synaptophysin and CD 56 positivity. He was suggested medical management for prostate cancer complicated by Cushing's syndrome. Unfortunately, Cushing’s syndrome was not controlled and the patient’s clinical condition progressively worsened. Subsequently, he developed fatal sepsis due to immunocompromised state. This case report describes a case of Cushing’s syndrome due to metastatic adenocarcinoma of the prostate, a tumour with very few therapeutic options and negative prognosis. JCMCTA 2020 ; 31 (1) : 125-129