Pre-terminal disease will influence glycaemic control
- goal of treatment is to avoid hypoglycaemia and manage symptoms of hyperglycaemia (balance against burdens of additional treatment and monitoring)
- Type 1 diabetes has an absolute insulin requirement (wish to avoid diabetic ketoacidosis)
- little evidence to guide best practice
- individualised treatments, particularly in Type 2 diabetes.
Additional symptom burden to patients may include:
- Hyperglycaemia: dry mouth, thirst, lethargy, blurred vision, polyuria, recurrent infections
- Hypoglycaemia: sweating, hunger, trembling, blurred vision, headache, confusion and disorientation, drowsiness, unconsciousness/coma, seizures.
Potentially reversible issues: infection
- stop or limit drugs which adversely influence blood glucose
- avoid hyperosmotic hyperglycaemic states.