From the Guidelines
Insulin lispro should be discontinued in a hospice patient, as the focus shifts from tight glucose control to maximizing comfort and quality of life, and the risks of hypoglycemia often outweigh the benefits, as stated in the 2022 standards of medical care in diabetes 1. In hospice care, the primary goal is to prevent distressing symptoms and preserve quality of life and dignity, rather than achieving strict glucose control 1. For patients with type 2 diabetes, discontinuing all medications, including insulin lispro, may be a reasonable approach, especially if they have limited oral intake and are in the final days to weeks of life 1. However, for patients with type 1 diabetes, some form of insulin therapy, often at reduced doses, should typically be continued to prevent diabetic ketoacidosis and its associated uncomfortable symptoms 1. Key considerations in this decision include:
- The patient's goals of care and life expectancy
- The risk of hypoglycemia and its potential impact on quality of life
- The presence of symptoms such as excessive thirst, frequent urination, and confusion, which may indicate hyperglycemia
- The potential benefits of simplifying the insulin regimen to reduce the burden of frequent injections By prioritizing comfort, symptom control, and quality of life, healthcare providers can make informed decisions about insulin therapy in hospice patients, as guided by the 2022 standards of medical care in diabetes 1.
From the Research
Insulin Management in Hospice Patients
- The decision to discontinue insulin lispro in a hospice patient should be based on individual patient needs and goals of care 2.
- Studies suggest that tight glycemic control may not be necessary for hospice patients, and a more relaxed approach to blood glucose management may be appropriate 2.
- Insulin lispro is a rapid-acting insulin that can help manage postprandial glucose spikes, but its use in hospice patients may need to be re-evaluated in the context of the patient's overall health and quality of life 3, 4.
Considerations for Discontinuing Insulin Lispro
- The risk of hypoglycemia is a significant concern in hospice patients, and discontinuing insulin lispro may help minimize this risk 2, 5.
- However, completely discontinuing insulin therapy may not be necessary, and a more gradual reduction in insulin dose may be a better approach 2.
- The patient's overall health status, including their nutritional status, mobility, and presence of other comorbidities, should be taken into account when making decisions about insulin management 2, 3.
Alternative Approaches to Insulin Management
- Keeping blood glucose levels between 200 and 300 mg/dL may be a more appropriate goal for hospice patients, rather than striving for tight glycemic control 2.
- Educating healthcare providers about the unique needs of hospice patients and the importance of individualized care plans is crucial in ensuring that patients receive optimal management of their diabetes 2, 3.
- Further research is needed to determine the best approach to insulin management in hospice patients, including the use of insulin lispro and other insulin analogs 5, 6.