ABSTRACT
The prevention of symptomatic hyperglycaemia remains crucial in the management of the patient with diabetes who is terminally ill. Active management of symptomatic established complications is also important to ensure patient comfort and minimize distress for relatives and carers. It should be expected that diabetes control may be lost in patients who are terminally ill, because of the neuroendocrine responses to stress, which are hyperglycaemic; immobilization, which reduces peripheral tissue glucose consumption; drug effects, which may cause insulin resistance (classically steroid therapy); and the stress response to intercurrent infections. On the other hand, reduced appetite and anorexia may enhance the hypoglycaemic effects of any pharmacological therapy used for diabetes.
