Aim To review the current management of patients with diabetes in their last days of life.
Background An estimated 25% of patients in palliative care settings have diabetes (or steroid induced diabetes) (Diabetes UK, 2018). The focus of care for these patients should be comfort; avoiding unnecessary blood sugar testing, preventing symptomatic high and low blood sugar levels, while keeping medication burden to a minimum.
Method Audit of notes (16–23 January 2018) of patients who died with diabetes and were on the end of life care pathway. We reviewed if there had been discussion with the patient surrounding diabetic management, whether there was a review of diabetic medication and a review of blood sugar testing. We audited how often patients had their blood sugars checked in their last seventy-two and twenty-four hours of life and if there were any high (>20) or low (<4) blood sugar recordings. We also looked at when diabetic medications were stopped.
Results A total of 21 patients were included. There was one (5%) documented discussion with the patient surrounding diabetic management at the end of life. There was one (5%) review of diabetic medication and four (19%) reviews of blood sugar testing. On average patients had their blood sugar checked five times in their last seventy-two hours of life (range 0–14) and twice in their last twenty-four hours (range 0–5). Hyperglycaemic episodes were recorded on two occasions and a hypoglycaemic episode was recorded once. Of those patients on oral agents (five) these were stopped between 48–120 hours before death. Of patients on insulin (four) all patients had injections in their last 24 hours of life.
Conclusion Patients with diabetes make up a significant proportion of palliative populations. We currently are not discussing with patients about how best to manage their diabetes, resulting in numerous blood sugars tests, high and low blood sugars and a significant medication burden.
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