June 18, 2026

5 Expert Tips on Managing Diabetes at End of Life

By Pallinews Editor Alison Ramsey

The Global Palliative Nursing Network recently hosted a webinar on “Caring for a Person with Diabetes at the End of Life: A Palliative Care Approach.” The tips and resources below are from the event’s panel of experts: Dr. Omar Mustafa, Kings College London; Dr. Emma Hall, a consultant at St. Christopher’s; and Dr. Terry Miseai, program manager at the Institute of Palliative Medicine, India. 

What is the goal? In the last year of a person’s life, clinicians need to shift their priority away from strict control of the patient’s blood sugar level: what the patient wants is crucial. The focus is now on preventing distress and controlling symptoms of hypoglycemia. 

How often should blood sugar levels be checked? Once or twice daily at most: if twice, do so in the morning and at night. “It’s cruel to do it four times a day.” Between 5 to 15 mmol/L is generally recognized as a palliative care objective. Symptoms develop if the level goes below or above.

Should those without a diabetes diagnosis be checked for low blood sugar? Yes, especially if they start taking steroids (for home visits, check glucose weekly) or if they display symptoms of hypoglycemia, such as early signs (thirst, dizziness, shaking, irregular heartbeat) or worsening symptoms (confusion, lack of coordination, slurred speech, blurry vision) that can be mistaken for dementia or other conditions. 

What if the patient’s appetite decreases? Take care to adjust the insulin, which can do more harm than good if it is overused. Diabetes near the end of life can undergo high and low swings: reassure families that this is a sign—not a cause—of dying. Disease-related hypoglycemia, as their body is closing down, will only last a few hours.

What are some common communication issues? It is very common in some countries for relatives to ask physicians not to tell the truth to patients about their prognosis, believing it would be harmful to their morale. But, Dr. Miseai said, “when I ask the patient what they think is happening, they often know.” He adds that a family meeting “is a very useful tool to bring everyone together,” including the patient, if possible. Invite decision-makers, who are not necessarily the primary caregiver. And employ patience when met with resistance. “Our goal is not to convince, but to come up with a shared plan.”

Recommended (all free to view or download)

• End of Life Guidance for Diabetes Care (United Kingdom, 2024)
• Guidelines for Managing People with Diabetes at the End of Life (Deakin University, 2010)
• Diabetes Management in Palliative Care (Pallipedia, 2019)
• Management of Type 2 Diabetes, section 25: Diabetes and End-of-Life Care (Australia, updated in 2026)