Managing diabetes is challenging, especially in palliative and end-oflife situations. The prime focus is usually on safety, comfort and quality of life rather than on achieving 'tight' blood glucose control. Preventing hypo-and hyper-glycemia is an important aspect of comfort and quality of life. The care plan and blood glucose targets need to be personalized to suit the individual's health and functional status, medicine regimen, risk profile and life expectancy, and, importantly, developed with the individual and sometimes their family carers. Once developed, the care plan should be monitored and reviewed regularly to accommodate changing health status and ensure the person's documented wishes are current. Key care challenges include detecting symptoms of hypoand hyper-glycemia and determining their underlying causes so appropriate care can be initiated. Health professionals often find it difficult to decide on a management plan and when to withdraw treatment in rapidly changing circumstances, especially if the person has not documented their wishes. The paper addresses key palliative and end-of-life care issues relevant to Type 1, Type 2 and corticosteroid-induced diabetes.
Practice points• Palliative and end-of-life care are important aspects of the diabetes disease trajectory; proactive end-of-life care planning could be incorporated into the annual diabetes complication screening process.• The key focus of palliative diabetes care is on undertaking appropriate assessments and monitoring that can guide care decisions, avoid unnecessary burden of care, and manage unpleasant symptoms to promote comfort and quality of life.• Care, including blood glucose ranges and HbA1c targets, should be individualized and adjusted to suit the individual's health and functional status, end-of-life stage, life expectancy, self-care ability and their end-of-life wishes.• Hypo-and hyper-glycemia cause distressing symptoms and stress and fear for people with diabetes on glucose-lowering medicines. Symptoms can be atypical and difficult to recognize for the individual and health professionals. Treatment might be delayed or not provided and the health professionals often under-rate the impact of hypo-and hyper-glycemia on the individual's mental and physical wellbeing.• Regular blood glucose monitoring helps identify hypo-and hyper-glycemia and enables appropriate treatment to be implemented promptly to reduce the metabolic and psychological impact.• The individual and their families should be involved in care decisions when possible, including proactively planning for end-of-life care.• It is important to support and educate family and other carers, including health professionals, during the individual's end-of-life journey and often during the bereavement period after death.For reprint orders, please contact: reprints@futuremedicine.com