Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach

Abstract

Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%–60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient’s autonomy, family expectations, and the current methods for treating the patient’s physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.

Predisposing factors for hypoglycaemia in the emergency department

“…The use of palliative care to treat hypoglycaemia in patients without DM mainly results in multiorgan failure (or severe liver, renal, or heart failure), sepsis, a state of exhaustion due to prolonged inadequate food and water intake, or cancer cachexia. 14 Patients who are at greater risk for hypoglycaemia also include those who have recently been admitted to the ward or ED and those who are under polypharmacy, particularly patients taking more than five medications. 15 Turchin et al.…”

Practical considerations when providing palliative care to patients with neuroendocrine tumors in the context of routine disease management or hospice care

“…In patients with symptoms related to peptic ulcer disease in patients with Zollinger-Ellison syndrome (ZES)/gastrinoma, proton pump inhibitors (omeprazole, pantoprazole) may be needed for patient comfort. Management of severe hypoglycemia related to insulinoma at end-of-life, besides SSAs, glucocorticoids such as dexamethasone, boluses of IV D50W or glucagon IV or IM may be given (Kok andLee, 2016, Gonzalez et al, 2015). Furthermore, diazoxide is used to manage hypoglycemia by inhibiting insulin secretion, however it can cause significant edema and it may require the use of loop diuretics (Hirshberg et al, 2005, Gill et al, 1997, Goode et al, 1986.…”