QuestionSBA
QuestionChoice
This is not appropriate or required here. Variable rate infusion is typically used peri-operatively or in medical patients who are not eating and drinking with erratic blood sugars.
10035966
e
Switch to variable rate insulin infusion
QuestionChoice
Insulin may need to be continued depending on his blood sugar control, this should be explored as opposed to immediately stopped.
10035963
b
Stop all diabetic medications
QuestionChoice
This is correct. The guidance related to diabetic management in end-of-life is primarily focused on symptom control as opposed to preventing long-term complications. Therefore, oral hypoglycaemics can be stopped and stopping insulin should be considered based on how erratic the control is. It is important to avoid symptomatic hyperglycaemia in end-of-life patients as this can be bothersome.
10035962
a
Stop all oral hypoglycaemics and consider whether insulin can be stopped
QuestionChoice
It is important to endeavour to honour patient wishes when the guidelines allow you to, particularly in palliative patients at the end of their life.
10035965
d
Continue all diabetic medications
QuestionChoice
This is not in keeping with guidance related to diabetes management at the end of life which advises stopping oral hypoglycaemics.
10035964
c
Stop insulin but continue oral hypoglycaemics
QuestionComment
So continue giving the dying man his insulin despite him not wanting it? Will I hold him down while we give it? 
53717
User
subscriber
Serotonin Migraine
Concept
Chapter
2693
6094
End of Life Care Medications
Topic
225
Oncology and Palliative Care
19596
In palliative care, it is often recommended to stop all oral hypoglycemics and consider whether insulin therapy can be discontinued, as the focus shifts to comfort and quality of life rather than strict blood glucose control.
A 76-year-old gentleman with metastatic colon cancer is dying in the oncology ward and in his last few days of life. He has poorly controlled type 2 diabetes mellitus and takes multiple medications including insulin and asks if his diabetic medications can be stopped.

What is the most appropriate management?
a