21st May 2025

Managing diabetes in the last weeks of life

During the last weeks of life, patients approaching EOL should have been identified. In keeping with the advice above, the patient’s medications should be rationalised and adjusted; however, there may be little time to get used to a new insulin regimen. Support should be sought from the diabetic team as help is often needed for dose adjustments, as well-being, activity and appetite can change daily. 

Also, choosing relaxing targets for control may seem like “giving up” for some patients and their families, whilst others may view managing diabetes in addition to their terminal illness as “futile”. The development of hypoglycaemia in people not previously prone to this is a poor prognostic sign.

The main aim of treatment here is to:

• Keep invasive tests to a minimum – look at the method and frequency of checking blood glucose levels. It is advisable to perform a single capillary blood test each day just before administering insulin to confirm that blood glucose levels fall within the desired range and to pre-empt the occurrence of hypoglycaemia.
• Be alert to hypo or hyperglycaemia symptoms and have appropriate medication/interventions available to address these if they develop. 
• Aim for a target blood glucose reading of 6-15mmol/L. 
• Rationalise the amount of medication needed to control their diabetes.