Management of Diabetes at the End of Life

Abstract

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 in Pregnancy

“…Statistics show that about 87-90% of diabetes in pregnancy is GDM, whereas 10-13% is pre-existing diabetes [5]. Further data also shows that diabetes complicates 2-45% of pregnancies across the globe, depending on the region, population characteristics, and diagnostic criteria [6][7][8].…”