Diabetics may often fare poorly in hospice care

an indication that there was room for improvement in their diabetes care.”

The study also looked at high blood sugar episodes, defined as blood sugar levels over 400 mg/dl.

High blood sugar — hyperglycemia — can cause excessive thirst and a need to urinate

All were 65 or older, and nearly all — 98 percent — were men. About 83 percent died before 100 days.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said, “The study findings bring up an important issue people to feel terrible, low blood sugar levels can also increase the likelihood of falls — a concern in hospice facilities and in nursing homes.

“If medications are not improving quality of life in hospice, it doesn’t make sense to use them.

“There are many newer medications that don’t cause lows and control the highs. They cost more, but you don’t have to monitor patients as much, so ultimately they’re likely cost-saving.”

Matt Petersen, managing director of medical information for the American Diabetes Association, said that the study added to the understanding of end-of-life care for people with diabetes.

Petersen said, “Hypoglycemia is to be avoided for safety and quality of life, but severe hyperglycemia is also to be avoided for the same reasons — left to go too high, glucose levels can lead to catastrophic (and very unpleasant) metabolic crisis.

“In patients that may not be eating well, estimating insulin dosing to match food intake can be challenging.

“It appears from the information provided that patients in the study were receiving individualized care based on their health condition, which is what the American Diabetes Association recommends for care.

“Care should involve a comprehensive consideration of what will ensure the best circumstances for the patient.”