Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach. (January 2017)

• Record Type: Journal Article
• Authors: Kok, Victor C.; Lee, Ping-Hsueh
• Is Part Of: Palliative care. Volume 10(2017)
• Publication Date: 2017-01
• Subjects: hypoglycemia -- nondiabetic -- palliative care -- shared decision -- lucid moments -- treatment withholding -- prognosis based; Palliative treatment -- Periodicals; Terminal care -- Periodicals; Palliative Care; Terminal Care; Palliative treatment; Terminal care; Electronic journals; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 616.029
• DOI: 10.4137/PCRT.S38956
• Languages: English
• ISSNs: 1178-2242

Abstract

Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%–60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient's autonomy, family expectations, and the current methods for treating the patient's physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.