Rationalising insulin therapy in palliative care

In addition to principles of rationalising antihyperglycaemic drugs, the approach to rationalising insulin therapy depends on the type of diabetes it is being used to treat:

• Patients with type 1 diabetes should continue insulin (adjusted to changing requirements) until the last days of life to prevent diabetic ketoacidosis; even in the last days of life administering a basal daily dose of long-acting insulin may still be reasonable
• Patients with type 2 diabetes can stop insulin in the last weeks of life.

Patients with palliative care needs may experience reduction in appetite and dietary intake. It is important to adjust insulin therapy to changing requirements. It is preferable to avoid short-acting insulin as dietary intake drops because of the risk of hypoglycaemia. If short-acting insulin is necessary, adjust to the patient’s dietary intake. A daily basal dose of long-acting insulin (eg insulin glargine) can reduce the risk of severe hyperglycaemia, with little risk of hypoglycaemia.