21st May 2025

Managing diabetes in the last year to months of life

Recognising people in their last year of life is essential and allows meaningful conversations about what matters most to the individual. It means individuals can express their views and priorities about future care. During this time, stringent blood glucose targets should be relaxed. Although there is no published evidence for target glucose or HbA1c levels, Diabetes UK suggests;

• Aim 1 – no glucose level less than 6 mmol/l 
• Aim 2 – no glucose level higher than 15 mmol/l

It is essential to recognise that the optimal range will vary according to the stage of illness, the individual’s ability to eat and drink normally, the presence of hypoglycaemia, the nutritional status, and the treatments given. 

As an individual approaches their last year to months of life, complex regimens should be reviewed and rationalised. It is much easier for the patient to be on insulin alone rather than multiple combinations of oral hypoglycaemic agents alongside insulin. Insulin regimens should be simplified, e.g. changing from twice to once daily (long-acting) insulin, even in patients with type 1 diabetes.