title: Management of Hypoglycemia in Nondiabetic Palliative Care Patients: A Prognosis-Based Approach.
abstract: Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%-60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode. Although it is not difficult to diagnose and confirm a true hypoglycemia when it is suspected clinically, an episode of hypoglycemic attack may go unnoticed in some patients in a hospice setting. Current trends in palliative care focus on providing treatments based on a prognosis-based framework, involving shared decision-making between the patient and caregivers, after considering the prognosis, professional recommendations, patient's autonomy, family expectations, and the current methods for treating the patient's physical symptoms and existential suffering. This paper provides professional care teams with both moral and literature support for providing care to nondiabetic patients presenting with hypoglycemia.
authors.affiliation: Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan.; Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Taichung, Taiwan.; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Kok
authors.affiliation: Division of Palliative Medicine, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan.; Division of Geriatric Medicine, Department of Family Medicine, Kuang Tien General Hospital, Taichung, Taiwan.
authors.forename: Ping-Hsueh
authors.initials: PH
authors.lastname: Lee
keywords: hypoglycemia; lucid moments; nondiabetic; palliative care; prognosis based; shared decision; treatment withholding