• Use this guideline in the last hours or days of life when oral intake reduced
• If not already explored, discuss changing approach to diabetes management with patient and/or family
• For further advice contact diabetes specialist nurses or palliative care team
• If patient remains on insulin, involve diabetes specialist nurses and agree monitoring strategy

Symptoms and tests

• Keep tests to a minimum
• It may be necessary to perform some tests to ensure unpleasant symptoms do not occur due to low or high blood glucose
• It is difficult to identify whether symptoms are due to hypo or hyperglycaemia in a dying patient
• If patient symptomatic, test blood glucose
• Observe for symptoms in previously insulin treated patient where insulin has been discontinued

Type 1 diabetes

• Always on insulin
• Prescribe once daily dose of long-acting insulin
• e.g. glargine based on 25% less than total previous daily insulin dose
• Check blood glucose daily at teatime
• if <8 mmol/L, reduce insulin by 10–20%
• if >20 mmol/L, increase insulin by 10–20%

Type 2 diabetes on insulin

• If patient’s total daily insulin dose is <0.3 units/kg, stop insulin
• if not appropriate to weigh the patient, use admission weight, last known weight or an estimate

If insulin stopped

• Check capillary blood glucose daily
• If blood glucose >20 mmol/L, give 6 units rapid acting insulin
• Recheck capillary blood glucose after 2 hr
• If patient requires rapid acting insulin more than twice, consider daily long acting insulin e.g glargine

If insulin to continue

• Prescribe once daily dose of long acting insulin
• e.g. glargine based on 25% less than total previous daily insulin dose
• Check blood glucose daily at teatime
• if <8 mmol/L, reduce insulin by 10–20%
• if >20 mmol/L, increase insulin by 10–20%

Type 2 diabetes not on insulin

• Stop treatment and stop blood glucose monitoring