The multidisciplinary diabetes team (MDT) will need to be proactive in recognising the onset of a patient’s terminal decline in health, and liaising with the appropriate EOLC services.

Conversely, those providing EOLC should ensure that the diabetes team is aware of the patient so that specialist guidance on the management of diabetes can be provided. EOLC services are focused on high quality end of life care, symptom management and the provision of psychosocial support with an agreed set of criteria to identify those who require urgent palliative care support worker responses in different Fulvestrant chemical structure situations, e.g. unresolved pain, rapid discharge from hospital or care breakdown at home. When palliative care is instituted there are several elements

of particular relevance to those with diabetes. Unnecessary tests such as frequent blood glucose INCB024360 manufacturer monitoring and complex insulin regimens are burdensome and should be avoided. An intervention required during relative health may not be indicated for the dying, with the caveat that patient preference is always of overriding importance. Patients, families and carers will often have spent many years striving for tight glycaemic control in an attempt to reduce the risk of long-term complications. They may find it difficult to understand that, when the end of life is imminent, maintenance of strict euglycaemia can be detrimental to quality of life and the avoidance of long-term complications becomes an irrelevant goal. Both patients and careers may require sensitive counselling from members of the MDT to explain the shift in glycaemic goals. Nevertheless, it is important to maintain adequate control to enhance comfort by preventing hyperglycaemia-induced thirst, dehydration, confusion, drowsiness and symptomatic hypoglycaemia.

Many elements presenting at the end of life predispose to alteration of glycaemic control; hyperglycaemia may result Carnitine palmitoyltransferase II from, for example: The stress response to severe illness. Disturbance in glucose metabolism caused by certain malignant tumours. Use of steroids for symptom relief. Co-existent infection. The insulin requirement may be reduced, with the consequent risk of hypoglycaemia as a result of, for example: Weight loss. Anorexia leading to malnourishment. Renal and/or hepatic failure. Oral hypoglycaemic agents may no longer be required and the involvement of an experienced dietitian can be invaluable for those with poor food intake. In many instances, diabetes is a co-morbidity in patients with a terminal illness such as cancer. Treatment regimens should be tailored to each individual by those with appropriate skills, in consultation with the patient and their carers.