Understanding Diabetes and Insulin
Worldwide, type II diabetes mellitus accounts for almost 10% of the population and was associated with almost 2 million deaths in 2016. Typically, diabetes affects those with a family history but can also arise idiopathically (without known cause). What this means for patients is frequent doctor’s appointments, diet modifications, and diabetic medications (potentially insulin). Normally, our pancreas secretes insulin whenever we eat in order to shift glucose from our blood to our cells. In patients with type II diabetes, the insulin in which the pancreas secretes fails to transfer glucose into the cells. As a result, blood glucose elevates. In order to lower blood glucose in patients with diabetes, extra insulin is needed to move insulin into the cells. Therefore, insulin is a common therapy for patients with diabetes. Diabetes management is crucial to prevent complications caused by the disease such as painful neuropathies, ocular toxicities, and renal toxicity.
“A big challenge when deprescribing medications in patients admitted to hospice is convincing the patient to discontinue insulin, especially, if they have been taking it for numerous years. A common fear is that their blood glucose will rise uncontrollably.”
Insulin for Hospice Patients
A big challenge when deprescribing medications in patients admitted to hospice is convincing the patient to discontinue insulin, especially, if they have been taking it for numerous years. A common fear is that their blood glucose will rise uncontrollably. However, elevated blood glucose itself is typically not associated with adverse symptoms on a short-term basis. An important note is that the complications listed above are long-term effects. Additionally, patients in hospice may not live to the point where they may experience these complications. Therefore, the need for insulin in these patients becomes moot. In patients who are actively dying, appetite tends to become nonexistent. If insulin continues to be administered, blood glucose can trend down to the point where the patient will be more likely to experience falls. In conclusion, discontinuing a hospice patient’s insulin reduces medication burden, is cost effective, and decreases the chance of injury due to inappropriate use.
By: Matthew Clark, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care, Hospice of Southern Illinois
October is American Pharmacists Month and we present to you a series of end-of-life topics throughout the month by our very own, Matthew Clark, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care! Our series will help expand your understanding of the field and debunk some myths in the field of pharmacy.
Topic 3: The Good Death
Read last week’s topic 2, End of Life Care Agents for Parkinson’s.
Our first post of the series, topic 1, click here, What is the difference in Palliative Care and Hospice?
Learn more about our pharmacy residency program here.