Palliative Care And Advanced Terminal Illness Care For Patients With Diabetes
Monika contacted TheDiabetesCouncil requesting information about diabetes management for patients who are in palliative care. Monika’s husband is in Memory Care for Alzheimer’s disease, and the staff was only checking his blood sugars two times per week for his Type 2 diabetes. They were not giving him his metformin anymore either, and they had started him on once daily injections of long acting insulin. Monika wasn’t sure if the steps taken by the staff to manage his diabetes were enough. His blood sugars were going up to 200 mg/dl, and sometimes even higher. She did state that he wasn’t having any low blood sugars. This was comforting to her because he gets more confused when his blood sugar goes low. They were also giving him desserts, and other unhealthy things, like fried chicken, on his tray. Was this ok, she asked? We decided to look into this for Monika. We found that the guidelines are less stringent in palliative care, and it was not so important to avoid long term complications for her husband. However, if Monika is uncomfortable with the palliative care, she should speak with the palliative care team at her husband’s Memory Care facility. They will usually work with the family to provide care that is more in line with what the family would want for the patient in palliative care. We hope this article on palliative care for those with severe illness, and those who are terminally ill, will help family members and patients alike. Now let’s take a closer look at what to expect in palliative care if you or your family member has diabetes. Distribution of Adults in need of palliative care The difference between palliative care and hospice Unlike hospice, a person can receive palliative care at any age, and you do not need to be in the terminal phase of Continue reading >>
Late Stage Complications Of Diabetes And Insulin Resistance
1Department of Microbiology, Chaitanya Postgraduate College, Kakatiya University, Warangal, India 2Department of Biotechnology, Presidency College, Bangalore University, India *Corresponding Author: Department Of Microbiology, Chaitanya Postgraduate College affiliated to Kakatiya University, Warangal, India E-mail: [email protected] Citation: Soumya D, Srilatha B (2011) Late Stage Complications of Diabetes and Insulin Resistance. J Diabetes Metab 2:167. doi:10.4172/2155-6156.1000167 Copyright: © 2011 Soumya D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes mellitus is considered one of the main threats to human health in the 21st century. Diabetes is a metabolic disorder or a chronic condition where the sugar levels in blood are high. Diabetes is associated with long-term complications that affect almost every part of the body and often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Also it is associated with significantly accelerated rates of several debilitating microvascular complications such as nephropathy, retinopathy, and neuropathy, and macrovascular complications such as atherosclerosis and stroke. In the present article it has been discussed about the resistance of insulin and its consequences in diabetic patients. Insulin resistance results in various disorders. Metabolic syndrome is predicted to become a major public health problem in many developed, as well as developing countries. Keywords Diabetes; Complications Continue reading >>
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The Symptoms Of Dying
You and I, one day we’ll die from the same thing. We’ll call it different names: cancer, diabetes, heart failure, stroke. One organ will fail, then another. Or maybe all at once. We’ll become more similar to each other than to people who continue living with your original diagnosis or mine. Dying has its own biology and symptoms. It’s a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions. Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren’t usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain. While few of us will experience all the symptoms of dying, most of us will have at least one, if not more. This is what to expect. We suspected the patient wouldn’t survive off the ventilator. A blood clot had crawled up one of the vessels in the back of his brain, blocking blood flow to the area that controlled alertness. He would die from not being awake enough to cough. The beat of the death rattle began when the breathing tube was removed and continued until life was done. It was a gurgling, crackling sound, like blowing air through a straw at the bottom of a cup of water. The average time between the onset of death rattles to death itself is 16 hours. For him, it was six. The death rattle is a symptom of swallowing dysfunction. Normally, our tongue rises to the top of the mouth and propels saliva, liquid or food backward. The epiglottis, a flap in the throat, flops forward to protect the swallowed substance from entering the airway. In the dying process, the symphony of swallowing becomes Continue reading >>
What Is Active Dying?
(855) 327-4677 Chat with Crossroads now. Email Active dying is the final phase of the dying process. While the pre-active stage lasts for about three weeks, the active stage of dying lasts roughly three days. By definition, actively dying patients are very close to death, and exhibit many signs and symptoms of near-death. For instance, actively dying patients are often times unresponsive, and their blood pressure drops significantly. Below is a list of some of the typical signs of active dying. While a patient may not experience all of the signs below, this list will help the patients loved ones and caregivers in recognizing and defining active dying. The signs and symptoms of active dying include: Long pauses in breathing; patients breathing patterns may also be very irregular Patient is in a coma, or semi-coma, or cannot be awoken Urinary and bowel incontinence and/or decrease in urine; urine may also be discolored Patients skin changes color (mottling) and their extremities may feel cold to the touch Continue reading >>
Management Of Diabetes In The End Stages Of Life
The purpose of this web page is to give all carers and health professionals information and points to consider that will enable the patient with diabetes to die with dignity and without suffering the more severe symptoms of uncontrolled diabetes. Diabetes management during terminal illness may be complex from a physiological, clinical and ethical perspective. The management of diabetes during the last few weeks of life may pose some problems for patients and for those caring for them. There is no agreed, evidence based guideline for end of life diabetes care. A number of physiological factors may influence glycaemic control during terminal illness. These include anorexia, cachexia, malabsorption, renal and hepatic failure. Drugs used in palliative care such as corticosteroid can have an impact of glycaemic control and monitoring will be required to assess their effects. The sedative effect of pain relief medication, for example opiates, can affect the patients ability to safely self manage their diabetes medications. Insulin omission can lead to diabetic ketoacidosis in people with Type 1 diabetes Aims of Management Provide the appropriate level of support to patients and their carers to: Avoid unpleasant osmotic symptoms of hyperglycaemia Avoid treatment associated hypoglycaemia Provision of quality care to manage and alleviate distressing symptoms Those in the early stages of palliative care should maintain their routine diabetes care. Those entering the later stages of their illness may need to have their diabetes medications adjusted to reduce the risk of hypoglycaemia but avoid symptomatic hyperglycaemia. Blood glucose monitoring Blood glucose monitoring is a useful tool to assess the efficacy of treatment regimens. There are no agreed target blood glucose levels a Continue reading >>
Asked And Answered Canadian Virtual Hospice
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 isnt much margin for safety if they go even lower. So its preferable to have high levels rather than low. Its 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 doesnt last more than a few days, and as long as fluid intake is maintained (with fluids that dont 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 persons 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 isnt 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 persons overall condition will affect the monitoring and treatment. Continue reading >>
What To Expect When Your Loved One Is Dying
Each person's journey to death is unique. Some people have a very gradual decline; others will fade quickly. As death approaches, your role is to be present, provide comfort, and reassure your loved one with soothing words and actions that help maintain their comfort and dignity. Hospice Care When your loved one's health care team recognizes that he or she is likely within 6 months of dying, they may recommend switching to hospice, a more specialized care for people with a terminal illness who are expected to die. Your loved one will still get treatment for pain relief and comfort, but hospice also offers emotional and spiritual support for them as well as you and close family. Signs That Death Is Near There are changes you can expect to see as an adult body stops working. These are a normal part of dying. Children and teens have a similar process, but it can be harder to predict. They often stay fairly active and continue to ask a lot of tough-to-answer questions. 1 to 3 months before death, your loved one is likely to: Sleep or doze more Eat and drink less Withdraw from people and stop doing things they used to enjoy Talk less (but if they're a child, more) 1 to 2 weeks before death, the person may feel tired and drained all the time, so much that they don't leave their bed. They could have: Different sleep-wake patterns Little appetite and thirst Fewer and smaller bowel movements and less pee More pain Changes in blood pressure, breathing, and heart rate Body temperature ups and downs that may leave their skin cool, warm, moist, or pale Congested breathing from the buildup in the back of their throat Confusion or seem to be in a daze Breathing trouble can be distressing for family members, but often it isn't painful and can be managed. Pain can be treated, too. But y Continue reading >>
How To Recognize When Your Loved One Is Dying
How to Recognize When Your Loved One Is Dying How to Recognize When Your Loved One Is Dying The dying process usually begins well before death actually occurs, and understanding this process can sometimes help you recognize when your loved one is dying. There are changes that take place physically, behaviorally, and psychologically in the journey towards death, that are signs that the end of life may be nearing. Death is a personal journey which each individual approaches in their own unique way. Nothing is concrete, and nothing is set in stone. There are many paths one can take on this journey but all lead to the same destination. What happens in the journey of dying, beginning one to three months prior to death, during the last two weeks before death, and during the last few days of life? In this continuum, how can you know when your loved one is dying? As a person comes close to death, the dying process begins; a journey from the known life of this world to the unknown of what lies ahead. As this process begins, a person starts on a mental path of discovery, comprehending that death will indeed occur and believing in their own mortality. The journey ultimately leads to the physical departure from the body. There are milestones along this journey. Because everyone experiences death in their own unique way, not everyone will stop at each milestone. Some may hit only a few while another may stop at each one, taking their time along the way. Some may take months to reach their destination, others will take only days. We will discuss what has been found through research to be the journey most take, always keeping in mind that the journey is subject to the individual traveler. The Journey Begins: One to Three Months Prior to Death The dying process starts to be recognizab Continue reading >>
Diabetic Coma
Print Overview A diabetic coma is a life-threatening diabetes complication that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. If you lapse into a diabetic coma, you're alive — but you can't awaken or respond purposefully to sights, sounds or other types of stimulation. Left untreated, a diabetic coma can be fatal. The prospect of a diabetic coma is scary, but fortunately you can take steps to help prevent it. Start by following your diabetes treatment plan. Symptoms Before developing a diabetic coma, you'll usually experience signs and symptoms of high blood sugar or low blood sugar. High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst Frequent urination Fatigue Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth A rapid heartbeat Low blood sugar (hypoglycemia) Signs and symptoms of a low blood sugar level may include: Shakiness or nervousness Anxiety Fatigue Weakness Sweating Hunger Nausea Dizziness or light-headedness Difficulty speaking Confusion Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness and won't have the warning signs that signal a drop in blood sugar. If you experience any symptoms of high or low blood sugar, test your blood sugar and follow your diabetes treatment plan based on the test results. If you don't start to feel better quickly, or you start to feel worse, call for emergency help. When to see a doctor A diabetic coma is a medical emergency. If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency nu Continue reading >>
Changes In The Last Hours And Days
Physical changes are likely to occur when you're dying. These happen to most people during the terminal phase, whatever condition or illness they have. This can last hours or days. You'll start to feel more tired and drowsy, and have less energy. You'll probably spend more time sleeping, and as time goes on you'll slip in and out of consciousness. Not wanting to eat is common in patients who are dying. At this stage, you may also find it difficult to swallow medicine. Your healthcare professionals can discuss alternative ways of taking medication with you and your carers, if necessary. Your family and carers may find it upsetting or worrying if you don't eat, especially if they see you losing weight, but they don't need to make you eat. As you get closer to dying, your body won't be able to digest food properly and you won't need to eat. If you can't swallow to drink, your carers can wet your lips with water. Your breathing may become less regular. You may develop Cheyne-Stokes breathing, when periods of shallow breathing alternate with periods of deeper, rapid breathing. The deep, rapid breathing may be followed by a pause before breathing begins again. Your breathing may also become more noisy as a result of the build-up of mucus. The body naturally produces mucus in your breathing system, including the lungs and nasal passages. When you're healthy, this mucus is removed through coughing. When you're dying and no longer moving around, the mucus can build up and cause a rattling sound when you breathe. Medicines or changes in the chemical balance of your brain can cause confusion or hallucinations. A hallucination is when you see or hear things that aren't there. If you become confused, you may not recognise where you are or the people you're with. Some people may exp Continue reading >>
Symptoms Of Late Stage Diabetes
ByBhadra Kamalasanan , Onlymyhealth editorial team Diabetes is characterised by high levels of glucose in the blood; the higher the glucose level in the blood the more a person is close to damaging his or her nerves as well as blood vessels that are spread throughout the body. High glucose level increases the vulnerability of the body to experience various health problems and decreases the bodys ability to fight infections. The foremost key to preventing frequent visits to the doctor includes regular check-ups and maintenance of blood sugar levels. The following are symptoms of late stage diabetes: Late stage diabetes is popularly known as diabetic nephrology i.e. kidney disease caused by diabetes, whereby the victim does not realise when the bladder is full. This leads the victim to not urinate whenever necessary and hence give rise to health problems such as urinary tract infections, cloudy urine, blood or foul smelling urine, frequent urination, chills, fever and back pain. About 35 percent of women and 75 percent of men with diabetes have sexual problems that may either be caused by circulation problems or nerve damage. Sexual problems in women include decreased vaginal lubrication, difficulty in becoming aroused, increased frequency of vaginal infections and fewer orgasms. Men may experience problem in getting an erection though the sex drive will remain normal; this problem is medically known as erectile dysfunction or impotence. The most prominent cause of gastrointestinal problem/s in diabetes is the delay in emptying the stomach after eating; it affects at least 40% of diabetics. Symptoms of the upper gastrointestinal include a feeling of fullness upon eating, heartburn , bloating and abdominal pain, anorexia, reflux and vomiting of the undigested food. The lo Continue reading >>
Signs And Symptoms Of Impending Death In End-of-life Elderly Dementiasufferers: Point Of View Of Formal Caregivers In Rural Areas
Signs and Symptoms of Impending Death in End-of-life Elderly DementiaSufferers: Point of View of Formal Caregivers in Rural Areas Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Japan *Correspondence to: Yoshihisa Hirakawa, Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya City, Aichi 466-8560, Japan. e-mail: [email protected] Received 2012 Mar 8; Accepted 2012 Jul 6. Copyright 2012 The Japanese Association of Rural Medicine This is an open-access article distributed under the terms of the CreativeCommons Attribution Non-Commercial No Derivatives (by-nc-nd) License. Objective: The aim of the present study was to clarify the signs andsymptoms of impending death in end-of-life senile dementia from the point of view offormal caregivers in rural areas. Patient/Materials and Methods: We used qualitative data based onretrospective analyses. The data was gathered following a workshop on end-of-life care ofthe elderly with dementia attended by formal caregivers that was held in Iga City, MiePrefecture, Japan, in September 2011. There was a total of 29 workshop participants. Theworkshop products were created in the first session of the workshop entitled Signs ofdeath. During the session, we used the brainstorming method, and participants took turnsstating at least two signs, symptoms or premonitions of death. In the end, there were 93cards in total displaying signs of impending death observed in the end stage of dementia.These 93 entries were then classified into clear categories. Results: The categories defined were breathing disorder, consciousnessdecline, vital power decline, reduced oral intake, feces disorder, calm and peacefulcharacter, bl Continue reading >>
Caring For Someone With Diabetes At The End Of Life
Caring for someone with diabetes at the end of life Caring for someone with diabetes at the end of life Please be aware - thisinformation is for healthcare professionals Diabetes is a serious life-long health condition. It occurs when the amount of glucose (sugar) in the blood is too high because the body cant use it properly. If left untreated, high blood glucose levels can cause serious health complications. There are two main types of diabetes: Type 1 and Type 2. Theyre different conditions and need to be treated and managed differently. Type 1 diabetes is an autoimmune condition where the beta cells (insulin-producing cells) in the pancreas are destroyed. The cause is partly genetic, and Type 1 diabetes is not preventable or related to lifestyle factors. Type 2 diabetes is a condition where glucose levels rise due to the bodys insulin not working properly (insulin resistance), or because the body produces less insulin, or a combination of both. Type 2 diabetes is associated with lifestyle factors such as obesity and physical inactivity, as well as genetic factors such as family history and ethnicity. Type 1 diabetes is treated with insulin via injections or an insulin pump. Type 2 diabetes treatment can include changes to diet, physical activity, weight loss (if indicated), oral medications, as well as insulin and non-insulin injectable medications. If a person has Type 2 diabetes and goes on to require insulin this does not mean they now have Type 1 diabetes. The general aim of treatment of both Type 1 and Type 2 diabetes is to maintain blood glucose levels as close to the non-diabetes range as possible. This reduces the risk of the person developing diabetes-related complications. Diabetes UK has more information about target blood glucose levels. At the end of l Continue reading >>
6 Emergency Complications Of Type 2 Diabetes
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes. Heart Attack Heart disease and stroke are the top causes of death and disability in people with diabetes. Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort. If you experience any of the following heart attack warning signs, call 911 immediately: Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms Shortness of breath Nausea or lightheadedness Stroke If you suddenly experience any of the following stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death. Stroke warning signs may include: Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body Feeling confused Difficulty walking and talking and lacking coordination Developing a severe headache for no apparent reason Nerve Damage People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection Continue reading >>
Early Death Warning As Diabetes Crisis Worsens
The National Diabetes Audit, which covers England and Wales, found diabetics have a 73 per cent greater risk of being admitted to hospital for heart failure compared with the rest of the population. The review of more than two million with the condition found 28 per cent of admissions to hospital for heart failure were among diabetes sufferers. These patients were also found to have more than quadruple the odds of dying in the following year. The risk of premature death among people with diabetes was also much higher – with 24,900 more deaths in 2012 than would normally be expected. Among people with Type 1 diabetes, which usually develops in childhood, 3,300 died in 2012, compared to the 1,440 expected among the same number of the general population. This means people suffering with Type 1 diabetes have a 129 per cent increased risk of death, according to the audit. Of those with Type 2, which is largely avoidable and linked to unhealthy lifestyles and obesity, 70,900 died in 2012. Among the same number of the general population the figure would be estimated at 52,800. This gives a 34 per cent increased risk of death for people with Type 2 diabetes. The audit is managed by the Health and Social Care Information Centre in partnership with Diabetes UK. Dr Bob Young, clinical lead for the audit and a consultant diabetologist at Salford Royal Hospital, said: “This audit is a wake-up call. Heart failure is preventable and treatable. “Every health professional should take note of how much more common heart failure is among patients with diabetes. “This report shows us that over and above the things we recognised as preventable complications of diabetes – heart attacks and stroke – there is this much greater number of people with heart failure. “If we all lived Continue reading >>
