Diabetics nearing the end of life face numerous complications carrying over from long-term medical conditions. In many patients, food intake is problematic, in addition to pain management for neuropathy. The primary concern of palliative or hospice care coordination is to ensure that the patient remains free from pain, gets adequate nutrition, and management of insulin and glucose levels. Neuropathy, the main pain concern, is a condition in which nerve pain radiates from the tip of the toes up to the knee. The pain can become constant and debilitating and generally accompanied by depression and sleep disturbances. The patient and family face several additional end of life issues and care provisions as well. For assistance with end of life issues and planning, all local hospitals and clinics have social workers, necessary legal forms, hospice and spiritual care providers at their disposal.
Care Provisions
Care provisions can be a concern for diabetics and their loved ones. Decisions will likely need to be made during the planning stages of end of life care. These decisions will include professional and family caregiving, home health and hospice care services, hospitalization and standing orders. According to Family Caregiver Alliance, these plans should be made well before needed so that family members are not left to make decisions that may be going against the wishes of the dying. Issues usually include whether to perform cardiopulmonary resuscitation, to call for emergency services and the decision to exhaust all medical procedures to prolong life.
Psychological Issues
Psychological issues involved with end of life decision making in diabetics can be justifiable and difficult. American Family Physician suggests that a poor prognosis can instantly place patients in the throes of preparatory grief and clinically observed depression, suicidal ideation and overwhelming fear and anxiety regarding the future. A psychologist can use talk therapy with the patient to sort through issues pertaining to dying, just as medications can be prescribed to decrease symptoms or improve sleep.
Spiritual & Existential Issues
Diabetics facing the end of life may also experience spiritual and existential crises. Spiritually and existentially, the dying have conflicting thoughts related to their place in the world, their relationship with a Higher Power, and where their souls go after their time on Earth is over. A chaplain or spiritual counselor is always available through referral by the patient's clinic, hospital, hospice or religious affiliation's visiting ministry care group. According to Compassion and Choices.org, patients do have the option of discussing their plans and final wishes with the visiting ministry in the event that they feel their loved ones may not agree or follow through as desired.
Legal Issues
Legal issues may also arise in the diabetic patient nearing the end of life. Living wills and advance directives for ambulatory care upon physical or mental incapacity are important documents that need to be completed and filed with the hospital and an attorney or other representative in advance. Most clinics and hospitals will have these forms readily available, and a copy of the advance directives should be placed in the patient's file. These important documents ensure that care and services are aligned between family and professionals regardless of complaints or desires for alternative treatment wishes from concerned others. These are legally binding documents that can only be rescinded by the patient. Other legal issues listed by the Family Caregiver Alliance that may arise involve durable powers of attorney, revocable living trusts, the designation of a representative payee and the conservatorship/guardianship of estate and person. These forms can be obtained through legal document websites or an attorney for hire.
