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Palliative And End-of-life Care For Patients With Diabetes

Palliative And End-of-life Care For Patients With Diabetes

Palliative and end-of-life care for patients with diabetes Diabetes complications are common and can contribute to unpleasant symptoms, depression and reduced quality of life. A palliative approach to diabetes care in patients with complications, including modified metabolic targets, can reduce symptoms and hospital admissions and improve quality of life and care transitions. GPs have a key role in co-ordinating palliative and end-of-life care in these patients. Palliative care aims to improve comfort and quality of life, optimise function and help patients make decisions about their end of life. A palliative approach can start early in the course of diabetes care for patients with complications and comorbidities and can be combined with active diabetes treatment. Key strategies in palliative care for people with diabetes include modifying glycaemic targets, minimising hyperglycaemic and hypoglycaemic episodes, managing medicines (particularly diabetogenic medicines), maintaining nutrition and hydration, and supporting family and carers. The Gold Standard Prognostic Indicator and assessment of the end-of-life stage can help GPs determine life expectancy, which can aid GPs, patients and their carers in deciding when to withdraw treatment. Picture credit: and.one/Dollar Photo Club. Continue reading >>

Hpna News: Management Of Diabetes At End Of Life

Hpna News: Management Of Diabetes At End Of Life

HPNA NEWS: Management of Diabetes at End of Life May 2008, Volume :26 Number 5 , page 276 - 277 [Free] Join NursingCenter to get uninterrupted access to this Article Diabetes mellitus is a metabolic syndrome characterized by hyperglycemia resulting from insufficient insulin secretion, insulin action, or both. Approximately 21 million children and adults in the United States have diabetes mellitus. Unfortunately, about 6.2 million of these cases remain undiagnosed. Additionally, more than 50 million people in the United States are thought to have "prediabetes" ( American Diabetes Association, n.d. ). Their glucose levels are higher than normal, but insufficiently high for a diagnosis of diabetes ( American Diabetes Association, n.d. ). Patients with life-limiting illnesses are more likely to have diabetes than the general population due to advanced age, the high prevalence of cancer (patients with cancer are more likely to have diabetes than those without cancer), and the use of medications that may elevate blood glucose. Diabetes exists as 2 primary "types." Type 1 diabetes is predominantly an immune-mediated disease, resulting in autoimmune destruction of insulin-producing beta-pancreatic cells. Patients with type 1 diabetes are dependent on exogenous insulin secretion. They represent approximately 4% to 5% of all patients with diabetes. The vast majority of diabetes patients have type 2 diabetes. These patients experience insulin resistance and a relative lack of insulin production. Type 2 diabetes is managed with medical nutrition therapy, exercise, and medications if necessary to improve insulin sensitivity as well as action or to enhance insulin secretion. Many patients with type 2 diabetes also use insulin as part or their entire management plan. Significant rese Continue reading >>

Importance Of Glycemic Control In Cancer Patients With Diabetes: Treatment Through End Of Life

Importance Of Glycemic Control In Cancer Patients With Diabetes: Treatment Through End Of Life

Importance of Glycemic Control in Cancer Patients with Diabetes: Treatment through End of Life We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Importance of Glycemic Control in Cancer Patients with Diabetes: Treatment through End of Life Cancer patients with diabetes are at increased risk for developing infections, being hospitalized, and requiring chemotherapy reductions or stoppages. While it has been hypothesized that glycemic control increases the risk for these adverse events, few studies have explored this hypothesis. The purpose of this paper is to discuss the importance of glycemic control in patients with diabetes and cancer during treatment through end of life. Glycemic control was found to play a role; the overall level of health-related quality of life experienced by patients with cancer and diabetes, level of symptom severity experienced and can impact the overall survival of the individual. Evidence-based policies and practice guidelines also need to be developed to help clinicians manage these patients during all phases of care. Using diabetes educators and advance practice, nurses to provide management and care coordination services need to be considered. Survivorship care plans should address both cancer and diabetes management. Finally, glycemic control should continue through end of life, with the main goal of avoiding hypoglycemic events. Keywords: Cancer, chemotherapy, diabetes, end of life, glycemic control Continue reading >>

Palliative Care And Advanced Terminal Illness Care For Patients With Diabetes

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 >>

What To Expect When Your Loved One Is Dying

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 >>

Diabetes Management And Pallatve Care: Example Of Turkey

Diabetes Management And Pallatve Care: Example Of Turkey

Diabetes management and pallatve care: Example of Turkey Faculty of Health Science, zmir Katip elebi Univesity, Izmir, Turkey igli District Training and Research Hospital, Izmir, Turkey Palliative care is a multidisciplinary approach to achieving the best quality of life in order to prevent or relieve the symptoms that may occur in people with serious illnesses. Diabetes affects about 171 million people worldwide. Current United Kingdom prevalence of diabetes in people over 65 is 10%. In 2005 about 10 million people were diagnosed with cancer. For this reason, a limited number of sources have been used in the writing of this compilation and it is thought that this literature which is missing in our country will contribute to this literature. diabetes, palliative care, glycaemic control, end of life Palliative care is a multidisciplinary approach to achieving the best quality of life in order to prevent or relieve the symptoms that may occur in people with serious illnesses. It is not only the maintenance done during the last period of life, but regardless of the disease stage, medical care is a form of treatment that must be integrated both during curative and lifespan during prolonged care. The primary role of palliative care is to relieve all physical and emotional symptoms, primarily pain [1,2]. When palliative care is initiated early in serious illness, it provides a more meaningful favor in terms of clinical and quality of life [3]. Palliative care includes those investigations needed to better understand and manage distressing clinical complications. Improving the outlook toward life of patients and their families facing life-threatening illness through prevention and relief of suffering defines palliative care. In palliative care, early diagnosis in the manageme Continue reading >>

Asked And Answered Canadian Virtual Hospice

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 >>

Racgp - 15. Diabetes And End-of-life Care

Racgp - 15. Diabetes And End-of-life Care

To minimise the risks of hypoglycaemia and metabolic compensation, a blood glucose range of 615 mmol/L is appropriate for most palliative care patients Maintain at glycated haemoglobin (HbA1c) at no lower than 58 mmol/mol (7.5%) if on hypoglycaemic medication depending on the individuals life expectancy, as HbA1c will be less relevant in patients with months or days left to live *Refer to Summary, explanation and source of recommendations for an explanation of the level of evidence and grade of evidence The aim of glycaemic control in patients at the end of life changes from preventing and managing long-term complications of diabetes to preserving quality of life. Terminally ill patients often have multiple factors affecting their glycaemic control (refer to Box 11). Glucose-lowering therapy should be tailored to minimise the risks of hypoglycaemia and hyperglycaemic states and symptoms. Box 11. Factors affecting glycaemic control in patients with type 2 diabetes at end of life Stress response to severe or sustained illness Difficulty taking medications (eg difficulty swallowing, nausea, stress) Hyperglycaemia can worsen pain, confusion, thirst, cognition, confusion and incontinence. Blood glucose levels >15 mmol/L may cause polyuria and increase risks of infection. Hypoglycaemia can also cause discomfort, confusion and impaired cognitive function. DKA can mimic terminal illness. If not recognised and treated, it can severely impair quality and even duration of life. Although there is little evidence about optimal blood glucose range, it is generally agreed that a range of 615 mmol/L is appropriate for most palliative care patients to optimise patient wellbeing and cognitive function.266,267 Aim to provide an appropriate level of intervention according to stage of illn Continue reading >>

Early Death Warning As Diabetes Crisis Worsens

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 >>

Diabetic Coma

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 >>

Late Stage Complications Of Diabetes And Insulin Resistance

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 >>

Management Of Diabetes In The End Stages Of Life

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 >>

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 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 >>

Management Of Severe Hypoglycemia At The End Of Life In Non-diabetic Patients: A Case Study And Recommendations

Management Of Severe Hypoglycemia At The End Of Life In Non-diabetic Patients: A Case Study And Recommendations

aTrustBridge Health, 5300 East Avenue, West Palm Beach, FL 33407, USA bHospice & Palliative Medicine Fellowship Program, University of Miami Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA cCorresponding Author: Faustino Gonzalez, TrustBridge Health, 5300 East Avenue, West Palm Beach, FL 33407, USA Manuscript accepted for publication August 13, 2015 Short title: Management of Severe Hypoglycemia doi: We present a case of a patient with metastatic synovial cell sarcoma of the lung with paraneoplastic production of insulin like growth factor (ILG-F) whose main symptom was generalized weakness due to severe hypoglycemia, and we also provide a brief discussion of the management of hypoglycemia at the end of life. Keywords: Paraneoplastic, Hypoglycemia; End of life; ILG-F When blood glucose level falls below 70 mg/dL (3.9 mmol/L), most patients begin to exhibit symptoms of hypoglycemia, both sympathetic (tachycardia, palpitations, diaphoresis, and tremulousness) and parasympathetic (nausea and hunger). Symptoms of neuroglycopenia can appear at blood glucose levels of 50 mg/dL (2.8 mmol/L) and include irritability, confusion, blurred vision, tiredness, difficulty speaking, and headaches. The most severe complications of hypoglycemia include seizure, coma, and death, which can occur at blood glucose levels of < 40 mg/dL [1]. This severe hypoglycemia requires assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions [2]. Hypoglycemia is confirmed by documentation of Whipple’s triad: symptoms suggesting of hypoglycemia, a low plasma glucose concentration at the time of symptoms and resolution of the symptoms after the plasma glucose level is raised [3]. Hypoglycemia may also go unrecognized in th Continue reading >>

Symptoms Of Late Stage Diabetes

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 >>

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