Diabetes mellitus in the last weeks of life – case study and current literature review

A case of advanced pancreatic cancer and diabetes diagnosed in the last months of life is presented with current management recommendations. The priority of diabetes therapy in palliative care is to maintain good quality of life. The range of glycaemic targets is widened and raised while shortening life prognosis. Avoiding hypoglycaemia and high, symptomatic hyperglycaemia is the most important. The use of oral hypoglycaemic agents is recommended at blood glucose > 15 mmol/l (270 mg/dl) but is often contraindicated due to renal/heart failure, hypotension, or periodic hypoglycaemia. Symptomatic hyperglycaemia > 16.7 mmol/l (300 mg/dl) often requires sole insulin implementation and fluid/electrolyte balance compensation. Intensive insulin therapy is used in the case of diabetes acute decompensation caused by potentially reversible causes (e.g. infection). In the stable phase of the disease long-acting insulin/analogue management is usually sufficient. In type 2 diabetes at the end of life pharmacotherapy discontinuation may be needed.