Glucose control in hospice

Queen Evita · Jul 4, 2012

Dear Coogabooga,

i´m a hospice nurse in Germany......most of the the time the physician orders to check the glucose level 3 times a day. But when you sure that the patient is going to die in the next 2 or 3 days we don´t check the level because it´s not longer importent for the patient. And that´s what we telling the familie members. No it´s time to go and for what do check the level? With what for a consequence? And most of the familie members understand that,also why the patient must not have any more pain about the stick for the glucose level....i hope these information can help you....best regards from germany.....

curiousauntie · Jul 7, 2012

If the patient is new to hospice, and they or the family feel it is necessary to check glucose, I go with some gentle teaching...5 times a day is a bit excessive, maybe cut to 2 times, a fasting and before dinner. I rarely have home patients who check that often anyway. You will find that as you get to know the family and they get to know you, they will be more open to listening to (hospice) reason. A lot of times the patient is just using the glucose testing as a form of control. Control over their situation, control of a body that is going out of control due to disease. Testing and keeping glucose levels in check is something they have possibly been doing for a long time and unless they are immanently dying, or it causes pain (physical or emotional) it is not doing any harm. If they are in the active dying phase, then the family needs to understand that the glucose levels are going to be off the chart, up or down, due to the massive changes in the body, and at that point they may be doing much emotional harm to themselves. Get the doc to write/sign an order to stop glucose testing. If the family is still testing as the patient is dying, they need the hospice nurse to take control of the situation.

coogabooga · Jul 7, 2012

Those are great responses. I often find it isn't the patient obsessing over the sugars, but the caregiver. Teaching (over and over again) about the hospice objective is imperative.

caliotter3 · Jul 7, 2012

Not hospice, but close. We had a resident at a LTC facility who was declining. We went to comfort measures only, but continued to deal with the blood sugars. I was told by another nurse that this was done primarily in the presence of the family so that they would think that their family member wasn't just allowed to lay in the bed, declining. Apparently no one explained to the family the change to comfort measures.