Diabetes patient persists on hospice care

DEAR DR. ROACH >>

My dad has been on hospice care for several months now. He had an untreated wound infection that was not responding to meds, so he went on hospice. Also, his wife died, and he lost the will to live after that.

His sugars are well into the 400s. He is on pain meds and nothing else. His doctor says he should not have lasted this long, medically speaking. He gave me no other explanation except a shrug. His spirits are OK, but I fear something else will get him in the end, like bed sores, pneumonia, a fall or COVID. Is it normal for a diabetes patient who no longer takes their medication to linger like this? He is not suffering per se, but quality of life is not good either.

— H.D.

DEAR READER >> The goal of hospice care is to provide comfort to a person in the last phase of their life. If your father was thought by his physician to have a condition that was likely to end his life (normally, an expectation of end of life coming within six months is a necessary condition for hospice care), and he made up his mind to choose this option (and understood the consequences of that action), then hospice is a reasonable choice.

Elevated blood sugars in people in hospice care are common. They are often not treated, as they usually do not cause symptoms.

Elevated blood sugars over months (or years) predispose people with diabetes to complications, including infection, heart disease and stroke, but in a person in hospice care, these considerations are less important than the overall goal of reducing suffering. Medications are given orally whenever possible and, again, only to relieve symptoms.

Something will indeed “get him in the end,” as it will for all of us. People in hospice care have accepted that.

It can be hard for family members, especially when there is not an immediately terminal disease like cancer associated with the hospice care.