Diabetes and Palliative Care

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Diabetes and Palliative Care

• Theresa Smyth
• Nurse Consultant in Diabetes
• University Hospital Birmingham NHS Foundation
  Trust

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Definition of Palliative Care

• is an approach that improves the quality of
  life of patients and their families facing the
  problem associated with life-threatening illness,
  through the prevention and relief of suffering by
  means of early identification and impeccable
  assessment and treatment of pain and other
  problems, physical, psychosocial and spiritual
• (WHO, 2002)

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Diabetes Management in Palliative Care

• Early stages manage conventionally
• Prognosis short term
• Control Symptoms
• Polyuria / Nocturia
• Excessive thirst and appetite
• Weight Loss
• Lethargy
• Blurred Vision
• Skin infections
• Vaginal infections
• Avoid acute complications of DM

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Acute Complications Diabetic Ketoacidosis

• Type 1 and type 2 diabetes
• Cause
• Absolute insulin deficiency
• Relative insulin deficiency
• Body fat broken down to produce energy
• Ketones cause acidosis
• Left untreated causes coma and death

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Acute Complications Hypoglycaemia

• Blood glucose less than 3.5mmols
• Caused by
• too much insulin / insulin stimulating medication
• lack of food
• Symptoms
• Sympathetic nervous system
• Neuroglycopenia
• If untreated may cause unconsciousness and death

• Difficult to treat
• Concomitant anorexia
• Nausea and vomiting
• Poor venous access
• Invasive and intrusive treatments
• Relaxed glycaemic control
• 5-15mmol/l

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Lack of appetite and weight loss

• Statistic
• Sense of smell and taste may diminish

• Dont discourage diet
• Oral hypoglycaemic agents and /or insulin

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Nausea and vomiting

• Common
• Management
• Type 1
• Insulin to prevent ketoacidsosis
• Change or reduce if poor intake
• Anti-emetics
• Sugary drinks
• Type 2
• Reduce or stop medication

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Conclusion

• Long term complications can be avoided / delayed
  with tight glycaemic control
• Palliative care may not require tight glycaemic
  control but acute complications and symptoms
  should be prevented

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Case Study 1

• George Smith age 70 has bowel cancer
• Has type 2 diabetes treated with Metformin 850mg
  tds and Gliclazide 80mg bd
• HbA1c 7.2
• Has rapidly declined not wanting to eat or drink
  taking sips of water only
• Has started having hypos

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Case Study 2

• Mary Jones, 65 years, advanced breast cancer
• Type 2 diabetes treated with NovoMix 30 26units
  am and 14units pm Metformin
• Has started to go off her food, husband is
  forcing her to eat
• HBGM 3-6 mmol/ls

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Case Study 3

• John Smith, age 37, has advanced cancer
• Type 1 diabetes on NovoRapid approx 16 units tds
  and Levemir 32 units bedtime
• Having frequent hypos, not wanting to eat very
  much
• HBGM 2-22mmol/ls