Dealing with Diabetes While Seriously Ill

By Mary Lynn McPherson, PharmD, PhD, CDCES

Whatis diabetes?

It’s a disease that affects how the body uses blood sugar (glucose). Diabetes occurs when your body can’t produce enough of a hormone called insulin, or the insulin your body produces doesn’t work as well as it should. Insulin is required so the sugar that comes from your diet can be used as energy for your cells and muscles.

When you don’t have enough insulin, or your insulin isn’t working correctly, your blood sugar goes up, and this can lead to complications. These complications can be ACUTE , including symptoms that develop quickly such as increased thirst, increased hunger, increased urination, blurred vision, headache, or confusion. With continued elevated blood sugar, diabetes can result in CHRONIC complications such as heart disease, stroke, vascular disease, kidney disease, vision problems, and nerve damage (causing numbness and tingling in the hands and feet).

It usually takes years of poorly controlled blood sugar for chronic complications of diabetes to develop. The good news is that good blood sugar control is much more important after the initial diagnosis of diabetes. If you have controlled your blood sugar for most of the time, you’ve had diabetes, this gives you a “protective” effect again the chronic complications of diabetes in later years.

What does this mean? It means you can focus on the goal of preventing the acute complications of diabetes more than the chronic complications. The acute complications of diabetes include high blood sugar (hyperglycemia, described above) and low blood sugar (hypoglycemia; symptoms include weakness, headache, shakiness, rapid heartbeat, dry mouth). Since your primary focus at this point is to remain comfortable, you can liberalize your diet somewhat, and in most cases, you can check your blood sugar less frequently. Your nurse will ask you if you have experienced any of the signs or symptoms of high or low blood sugar.

Your doctor may reduce the dose of your diabetes medication(s) or even stop them. While a “normal” blood sugar is between 80 and 150 mg/dl, your doctor is not as concerned about rigidly targeting this blood sugar. Remember, all those years you spent controlling your blood sugar was like putting money in the bank ; now it’s time to draw those dividends!

Signs and Symptoms of HIGH Blood Sugar (Hyperglycemia)

• Increased thirst

• Increased hunger

• Increased urination

• Blurred vision

• Headache

• Confusion

Signs and Symptoms of LOW Blood Sugar (Hypoglycemia)

• Weakness

• Headache

• Shakiness

• Rapid heartbeat

• Dry mouth

Work with your hospice nurse to discuss your diet, medications, symptoms you should report to the nurse, and how often you should check your blood sugar. If you or your family have any questions, talk to your doctor or hospice nurse. That’s what they are there for!

Mary Lynn

Signs and Symptoms of HIGH Blood Sugar (Hyperglycemia)

What does this mean? It means you can focus on the goal of preventing the acute complications of diabetes more than the chronic complications. The acute complications of diabetes include high blood sugar (hyperglycemia, described above) and low blood sugar (hypoglycemia; symptoms include weakness, headache, shakiness, rapid heartbeat, dry mouth). Since your primary focus at this point is to remain comfortable, you can liberalize your diet somewhat, and in most cases, you can check your blood sugar less frequently. Your nurse will ask you if you have experienced any of the signs or symptoms of high or low blood sugar.