Last stages of diabetes before death
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Understanding the Last Stages of Diabetes Before Death
Prevalence and Impact of Diabetes at End of Life
Diabetes mellitus is a significant condition affecting a substantial portion of the population at the end of life. Research indicates that more than one-fourth of the end-of-life population in the Netherlands had diabetes, with a notable proportion experiencing severe or intermediate disease status. This prevalence underscores the importance of understanding the complications and management strategies for diabetes in the terminal stages.
Common Causes of Death in Diabetic Patients
In patients with long-term diabetes, the primary causes of death are often related to complications arising from the disease. A study following patients diagnosed before the age of thirty-one found that 31% of deceased patients died from uraemia, and 25% from myocardial infarction . These findings highlight the critical impact of kidney and heart complications in the mortality of diabetic patients.
Complications Leading to Death
Several severe complications are prevalent in the last stages of diabetes. Persistent proteinuria and uraemia are common, with 38% of patients exhibiting proteinuria and 22% experiencing uraemia . Additionally, cardiovascular issues such as myocardial infarction and stroke are significant, with 21% showing signs of myocardial infarction and 10% of stroke . Other complications include blindness, severe vision impairment, and gangrene, which often necessitates amputation .
Medication Management in the Final Years
The management of diabetes medication in the last years of life is crucial for improving the quality of life. There is a trend towards discontinuing glucose-lowering medications as death approaches, with a significant reduction in medication use observed in the last year of life. This discontinuation is often aimed at reducing the medication burden and focusing on comfort rather than strict glycaemic control .
Blood Sugar Monitoring and Patient Comfort
In the final days of life, the focus shifts to minimizing discomfort from frequent blood sugar testing and managing symptomatic high and low blood sugar levels. Studies show that blood sugar levels are often checked multiple times in the last 72 and 24 hours of life, which can be burdensome for patients. There is a consensus among healthcare professionals that treatment and monitoring should be minimized in the terminal phase, especially for type 2 diabetes.
Conclusion
The last stages of diabetes before death are marked by severe complications such as uraemia, myocardial infarction, and other cardiovascular issues. Effective management strategies focus on reducing the medication burden and minimizing discomfort from frequent blood sugar monitoring. Understanding these aspects is crucial for providing compassionate and appropriate care to diabetic patients in their final days.
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