Insulin Management in Hospice Care: Balancing Comfort and Diabetes Control

Patients in hospice care who have diabetes often continue to require insulin. The hospice philosophy prioritizes comfort and quality of life over aggressive disease modification, but this does not mean discontinuing all medications. Symptom control—including preventing hyperglycemic crises or hypoglycemia—remains essential.

Clinical Approach

• Individualized plans: Insulin regimens are simplified (e.g., basal insulin only) to reduce burden and injection frequency.
• Target ranges: Blood glucose targets are liberalized (e.g., 150–250 mg/dL) to avoid hypoglycemia.
• Coordination: The hospice team collaborates with the patient's primary physician or endocrinologist for dosage adjustments.
• Route of administration: Subcutaneous insulin continues; insulin pumps may be managed by trained staff or family.

The goal is to maintain comfort without adding distress. Decisions are revisited regularly as the patient's condition, intake, and goals evolve.