Scribd Logo
Upload

Welcome to Scribd!

  • 71 views

    Palliative Care Intervention in The Management of Diabetes - DR Steve Jones

    Uploaded by

    malaysianhospicecouncil6240
    This document discusses palliative care intervention in the management of diabetes for patients with cancer. It provides an overview of the high rates of diabetes in cancer patients and explores some of the issues around managing blood glucose levels for palliative patients. The evidence section indicates there is little research on established guidelines. Management involves balancing the need for intervention with patient comfort and discussing a changing approach to diabetes care with the patient and family.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Palliative Care Intervention in The Management of Diabetes - DR Steve Jones

    Uploaded by

    malaysianhospicecouncil6240
    71 views30 pages
    This document discusses palliative care intervention in the management of diabetes for patients with cancer. It provides an overview of the high rates of diabetes in cancer patients and explores some of the issues around managing blood glucose levels for palliative patients. The evidence section indicates there is little research on established guidelines. Management involves balancing the need for intervention with patient comfort and discussing a changing approach to diabetes care with the patient and family.

    Original Description:

    10th Malaysian Hospice Congress, Johor Bahru, Malaysia

    Original Title

    Palliative Care Intervention in the Management of Diabetes_Dr Steve Jones

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses palliative care intervention in the management of diabetes for patients with cancer. It provides an overview of the high rates of diabetes in cancer patients and explores some of the issues around managing blood glucose levels for palliative patients. The evidence section indicates there is little research on established guidelines. Management involves balancing the need for intervention with patient comfort and discussing a changing approach to diabetes care with the patient and family.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    71 views30 pages

    Palliative Care Intervention in The Management of Diabetes - DR Steve Jones

    Uploaded by

    malaysianhospicecouncil6240
    This document discusses palliative care intervention in the management of diabetes for patients with cancer. It provides an overview of the high rates of diabetes in cancer patients and explores some of the issues around managing blood glucose levels for palliative patients. The evidence section indicates there is little research on established guidelines. Management involves balancing the need for intervention with patient comfort and discussing a changing approach to diabetes care with the patient and family.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 30

    Palliative care intervention in the management of diabetes

    Steve Jones Consultant Endocrinologist Dean of Clinical Affairs for NUMed Malaysia

    Contents
    An introduction An overview What are the issues? The evidence Management
    Practical issues Psychological issues

    Newcastle University Medicine Malaysia

    Contents
    An introduction An overview What are the issues? The evidence Management
    Practical issues Psychological issues

    Diabetes and Cancer


    346 million people have diabetes
    3.4 million die as a result of high glucose

    10 million people world wide are diagnosed with cancer each year. Over 7 million people die of cancer each year
    WHO 2011

    Diabetes and cancer


    The incidence of diabetes in people with cancer is six times that found in the general population.
    Quinn et al 2006

    More than 50% of people with cancer in Malaysia will have diabetes.

    Why is diabetes so common in people with cancer?


    Shared risk factors
    Age Obesity

    Cancer and its treatment raises glucose


    Treatment with corticosteroids Stress response

    Obesity and Cancer

    Central Adipose Tissues

    Contents
    An introduction An overview What are the issues? The evidence Management
    Practical issues Psychological issues

    Its tricky!
    Factors that increase glucose Factors that decrease glucose

    Stress response to illness Infection Surgery Steroids

    Weight loss Decreased appetite Nausea and vomiting

    What are the issues?

    Concern about guidelines


    Few established guidelines No protocols Trial and error approach with risk of suboptimal care

    Stage of illness changes targets


    Agreed
    Less strict targets needed in last few weeks and days of life.

    Concerns that
    Symptoms that might be caused or exacerbated by high glucose
    Breathlessness, dehydration, confusion, drowsiness

    The dilemma
    There is that tension between uncomfortable intervention [finger pricking] but avoiding discomfort from something that can be improved [diabetes control]

    Specific conditions
    Different approaches needed for different types of diabetes
    Type 1 Type 2 Steroid induced

    INSULIN TREATMENT!!

    Communication
    Patients with long standing diabetes may find it hard to change eating and testing patterns. it is important that they dont see cessation of insulin as kind of being an abandonment of all care

    Contents
    An introduction An overview What are the issues? The evidence Management
    Practical issues Psychological issues

    The evidence
    180000 160000 140000 120000 100000 80000 60000 40000 20000 0 23984 38 160461

    Diabetes
    MEDLINE search May 2011

    PC

    Both

    38 studies on Medline search


    Irrelevant 22 Diabetic neuropathy 11 Diabetes management 3 literature reviews 2 original articles

    Original articles 1. Audit of case notes 2. Survey and focus groups of palliative care and endocrinology practitioners

    Contents
    An introduction An overview What are the issues? The evidence Management
    Practical issues Psychological issues

    Guidelines
    Google search diabetes palliative care guidelines
    914 000 hits!
    www.cancernorth.nhs. uk

    Principles 1: Communication
    Discuss changing the approach to diabetes management with patient and/or family. If the patient remains on insulin agree monitoring strategy.

    Principles 2: Testing
    Keep invasive tests to a minimum.
    It is necessary to perform some tests to ensure unpleasant symptoms do not occur due to low or high blood sugars.

    It is very difficult to identify symptoms due to hypo or hyperglycaemia in a dying patient.


    If observed symptoms could be due to blood glucose levels a urine test should be performed, followed by a blood glucose check if necessary.

    Tips for patients on insulin


    People with T2DM taking > 48 units per day are likely to develop osmotic symptoms if insulin is stopped. Choices for once daily insulin
    Glargine Humulin I Insulatard

    Reduce total daily dose by 25%

    Contents
    An introduction An overview of the problem The evidence Management
    Practical issues Psychological issues

    Thank you for your attention

    You might also like