Diabetes management in palliative care is often tricky. Trying to optimise quality of life, and finding a balance between the burden of diabetes treatment (such as checking blood sugars, diabetic diet and medication side effects) and the sequelae of uncontrolled blood sugars (like unpleasant symptoms and infections) is difficult. As a patient’s weight, diet, metabolism and organ function change, the risk of hypoglycaemia (low blood sugar) increases. Adding further difficulty is that patients with chronic diabetes have often spent years being told that they need to keep strict control of their blood sugars, in order to avoid the awful long-term consequences of poorly-controlled diabetes. It can be difficult to convince patients, their families and carers blood sugar control can be relaxed in the palliative care setting.
As with many areas in palliative care, evidence regarding diabetes management is limited, and we rely on guidelines. Two such useful guides are the Australian-authored Guidelines for managing diabetes at the end of life and the Diabetes UK End of life diabetes care clinical care recommendations . For consumers, Palliative Care Australia has published helpful brochures for patients with diabetes and for families/carers, which can be downloaded from their website.
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