Treat diabetes?

[nursecathi]

I spent 30 years on the "save them at all cost" critical care side of nursing and just recently started in hospice. My question is--do you treat diabetes? Do you even check blood sugars? I'm curious because I had a patient recently who I'm sure was in DKA. She passed quickly (she was 94) and comfortably (?) as she had been medicated for her dyspnea from pneumonia, which was her diagnosis. It's an I patient unit if that makes a difference.

[Libby1987]

Depending on where they are in the dying process some do.

I'm not hospice btw but I refer my HH patients to hospice and this is one of topics discussed.

[softrbreeze]

Honestly, it just depends. I work home hospice so pts and families are encouraged to do what feels comfortable to them. Some people want to stop worrying about blood sugars and just eat what they want. That is fine. Some people want to continue monitoring blood sugars and eating an ADA diet. That is fine too. In an inpatient setting, they are usually closer to dying so I would start teaching that they should start eating and drinking as they please to make their last days as pleasurable and comforting as possible. You can continue to check blood sugars if they desire it but I would discourage that altogether. Is there a particular pt that is worrying you or is your concern more general?

[toomuchbaloney]

Treatment of blood sugars is entirely variable dependent upon the patient, the family, the hospice and medical director, and the status of the patient in terms of nearness to death.

If the patient is suffering secondary to blood sugar levels or is in danger of hastened death secondary to levels it is prudent to treat them...unless this is contrary to the wishes of the patient and family. Some diabetics prefer to stop all testing and all antidiabetic meds and to simply eat and drink as they prefer in their last days/weeks/months.

[vampiregirl, BSN, RN]

Just as you are transitioning your mindset from the "save them at all cost" to the "comfort care" perspective, the patient also has to make this transition:) Making a 180* change in thinking isn't easy for either one of you most likely!

Just like the previous posters mentioned, there are several factors that come into play when addressing blood sugars, diabetic meds etc. If the patient opts to continue addressing diabetes, I've found the oral meds are the ones I need to be monitoring as appetites/ intakes decrease towards EOL. Hypoglycemia (precipitated by oral meds) can be tough to address especially from the symptom management/ comfort perspective.

Don't just throw away all you learned in critical care though - this knowledge base can be applied to addressing symptoms by understanding from a physiological standpoint why they may be occurring. It also will help when you are teaching patients and families about the disease process and what to expect.

[TammyG]

Generally, we would treat diabetes if the patient wanted it treated and until the patient was at EOL. Although our MDs would write the orders for the diabetic medication, we would not pay for it, and the patient would rely on their other pharmacy benefits to pay for the medication. I found that most patients and families wanted to continue to treat it. They had become used to doing so.

[Nashvillejeanne]

The general thinking is you treat the symptoms that you see as they develop. If you "test" for something you have to already be thinking what are you going to do to "treat". For examply....pneumonia...you could get a CXR, then start ABT treatment...or...treat the symptoms that you see and allow the disease to take its course. You have to work with the family on this. I have seen it both ways.

[SHGR, MSN, RN, CNS]

The only patient that I ever had who wanted to continue to care about his diabetes on hospice was a gentleman who had had Type 1 for most of his life. He continued to check sometimes and he would eat whatever he wanted, with some mealtime insulin to match. He'd call the nurse's station saying things like "I'm going to have an ice cream, please give me 3 units of regular." So he had freedom that he had never had before, while staying out of DKA, so it was the cancer that took him and not the diabetes.

He found the balance that he wanted.

I never had a Type 2 patient or family that continued to worry about it after hospice was started.

[Nascar nurse, ASN, RN]

Comfort drives the plan of care. Ask yourself: Is the patient uncomfortable from xyz? If "no" then don't worry about it (patient/family decision plays a part in this too of course, but I also work to educate the family and gently remind them as needed that the only real goal here is comfort).

If they are uncomfortable about xyz, then the intervention becomes the least aggressive method you can provide to bring comfort.