Diabetes management during the end of life

Abstract

For individuals with diabetes, maintaining optimal glycaemic control is essential to reduce the risk of long-term complications. However, as patients approach the end of life, the emphasis on tight glycaemic targets becomes less relevant. Instead, the primary goal shifts to maintaining blood glucose levels within a range that minimises the risk of hypoglycaemia and prevents symptomatic hyperglycaemia, thereby ensuring comfort and quality of life. This article explores the transition from disease-focused management to a person-centred approach grounded in comfort, dignity and ethical responsibility. It examines the adaptation of glycaemic targets, deprescribing, nutrition, and monitoring across the recognised phases of dying, and addresses the specific challenges of managing type 1, type 2 and steroid-induced diabetes in palliative contexts. Ethical principles including autonomy, non-maleficence, beneficence, and justice are critically applied to nursing practice, alongside recommendations for interdisciplinary communication and advance care planning. Nurses play a pivotal role in delivering proportionate, compassionate, and ethically sound care for people dying with diabetes.