Dying well with diabetes.

Death is an inevitable part of living. There are undoubtedly clinical and psychological challenges when any individual is passing from life to death. For a person with a long-term condition such as diabetes, these challenges can be compounded and impact on the care and experience of both the individual and their families and carers. It is estimated that about 500,000 people die each year in the United Kingdom; of these approximately 75,000 will have diabetes. The vast majority of people with diabetes who die do not do so as a result of a metabolic diabetes emergency such as diabetic ketoacidosis or hyperosmolar hyperglycaemic state. Whilst diabetes is listed as one of the top 10 causes of death in developed countries, death occurs more commonly as a result of cardiovascular disease, dementia, respiratory disease, or cancer. Life-long care of people with diabetes centres on glycaemic management and other modifiable clinical elements such as blood pressure, renal function, and cholesterol. These factors may become less important to healthcare professionals caring for the individual who is approaching the end of their life and for safety and holistic reasons clinical targets may be made more liberal. For the person dying and their families and carers this may be a difficult concept to accept. This article is based on the Diabetes UK (2018) Diabetes and End of Life: Clinical Care Recommendations. Offering a comprehensive guide to the management of diabetes through all the stages of dying it provides information on hypoglycaemia and hyperglycaemia prevention and treatment, and the care of people taking glucocorticoid therapy with a previously known and not known diagnosis of diabetes. Controversial areas of care are discussed where there has been no clear consensus.