How is diabetes best managed at the end of life, when the goal is comfort?

When diabetes treatment is focused on making someone comfortable, the main goal is usually to avoid low blood sugar levels. Low levels cause the most symptoms in the short term and are most risky for the patient. There isn’t much margin for safety if they go even lower. So it’s preferable to have high levels rather than low.

It’s reasonable to aim for blood sugar levels in the 10-20 range. This means there will be times when levels are in the high 20s. As long as it doesn’t last more than a few days, and as long as fluid intake is maintained (with fluids that don’t contain sugar), then this is acceptable. In the short term, blood sugar levels in the 20-30 range usually cause increased thirst and urination. If levels stay in that range then the increased urination can cause serious dehydration, and even lead to coma.

When the goal of care is a person’s comfort, then diabetic medications may be reassessed, and testing and treatment simplified. Sometimes insulin can even be discontinued. If blood sugars are maintained without dipping too low, then testing can be reduced to every second day or to two or three times a week.

In the last days of life, a person probably isn’t eating and is drinking very little. At this time discussion with the patient and the health care team will focus on how often to monitor blood sugar levels and how to treat levels that are either too low or too high. The person’s overall condition will affect the monitoring and treatment.