According to the American Diabetes Association 2020 Standards of Care, 25% of patients over the age of 65 have diabetes and approximately 50% have pre-diabetes. Diabetes occurs when the body is unable to regulate sugar within the body. It is caused by a variety of reasons, but the most important is the body either cannot make insulin (Type 1) or the body becomes de-sensitized to insulin, and the body cannot make enough to compensate (Type 2). When diabetes is not controlled, there is risk for many complications including kidney disease, vision loss, and nerve pain. Blood sugar goals of 80 – 130 mg/dL in the morning and < 180 mg/dL after meals can help to slow the progression of complications. Medications for diabetes include metformin, sulfonylureas (glipizide and glyburide), and insulin. These are only a few examples of the large number of these medications available.
Kidney disease, vision loss, and nerve pain are all considered “long-term” complications of diabetes because the symptoms or body changes do not develop until there is years of damage from blood sugar levels that are not at the goals previously mentioned.
Short-term complications of diabetes are much more severe and can be life threatening. Diabetic keto-acidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are both conditions that can develop with blood sugar levels >300-400. If a patient is diagnosed with DKA or HHS, they will require hospitalization to manage the blood sugar levels. If untreated, the short-term complications can be deadly.
Another complication of diabetes management is hypoglycemia. Hypoglycemia is defined as a blood sugar level of < 70 mg/dL or anytime a patient develops symptoms of low blood sugar. Symptoms include tremors, irritability, hunger, dizziness, sweating (especially cold sweating), and confusion. Hypoglycemia, if untreated, can also be deadly. Fortunately, treatment is ingesting sugar through glucose tablets, soda, or other source of simple sugars followed by a small meal to ensure blood sugar levels don’t decrease again.
Understanding Treatment Options With End-of-Life Care
All diabetes medications can lead to hypoglycemia, and the more diabetes medications a patient takes, the higher the risk. When a patient enters hospice, the focus should be for maximum comfort and minimized side effects. Because these medications have a high risk for causing short term complications, like hypoglycemia, it is common to stop or at least decrease the doses of a patient’s medicine. The goals of 80 – 130 mg/dL are usually too strict for a patient at the end of life, and that also increases the risk for developing hypoglycemia. A typical goal blood sugar for an end of life patient is 200-300 mg/dL.
Because we are not concerned about long-term complications developing, the higher goal is safer at preventing low blood sugars. Stopping diabetes medications is never an easy decision for patients or their family members to make. But in the end, the patient will be safer because of it.
Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat,
By: Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care, Hospice of Southern Illinois
October is American Pharmacists Month. We are proud to present to you an educational blog series throughout the month by, Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care. Our series will help expand your understanding of the use of medications at the end-of-life.