Diabetes is a condition that occurs when there is an increased level of glucose in the blood (hyperglycemia). This is majorly caused either by the reduction in the production of the hormone (insulin) needed to absorb insulin from the blood or resistance of the body to insulin. Type1 and 2 diabetes are the two major types of diabetes. Symptoms of diabetes includes thirst, hunger, frequent urination, fatigue and hunger.  Treatment of diabetes aims at maintaining normal balance of glucose in the blood. Physicians accomplish this through regular monitoring of blood glucose, insulin therapy, diet and exercise.

With the increased quality of care in diabetes, patients can now live comfortably with diabetes. Data from CDC in 2015 indicates that more than 30.3 million Americans have diabetes, which is 9.5 percent of the population. The report also shows that among adults ages 18-44, 4 percent had diabetes. Among those ages 45-64 years, 17 percent had diabetes. And among those ages 65 years and older, 25 percent had diabetes.  This shows that diabetes is more prevalent in older individuals. Diabetes, being a chronic condition, requires appropriate management and care. Insulin therapy, designed to lower blood glucose concentration, is a primary methodology of Glycemic. Doctors utilize HBA1C estimations to monitor the blood glucose concentration in order to fine-tune the therapy.

Following the statistics of the CDC, some of the most at-risk for diabetes are those with advanced age or in hospice care. The management of diabetes in Hospice care tends to focus on an increased emphasis on comfortable care for the patient while maintaining methodical treatment.  Healthcare professionals working in Hospice care for patients with terminal illness that focuses on quality of care and comfort rather than cure or long-term benefits. For a diabetic patient, treatment evaluations rely on the benefits and need for glycemic control verses the pain of the blood draw procedure. In hospice care, goals must be properly defined based on the chronic disease. For diabetes in hospice care, glycemic goals are dependent on the patient’s risk of hypoglycemia. In older adults, the risk of hypoglycemia is higher due to factors such as impaired renal functions, slowed hormonal coordination and regulation, varied appetite etc.

Most patients in hospice care are of an advanced age, which presents a considerable risk of hypoglycemia. Cognitive impairment in these patients may also present difficulties in glucose monitoring and insulin dosage adjustment. Therefore, for proper management in hospice care, the focus must revolve around the avoidance of symptoms of hyperglycemia and prevention of hypoglycemia, rather than preventing long-term complications. The use of background, long-term insulin is encouraged while dietary restrictions are unlikely.  Some physicians have found success in a reduction of glucose test frequency and stopping or reducing disruptive medication.

Lastly, explaining the changes in care to a patient and their family is vital. The reduction of family and patient apprehension can often make or break a successful Diabetes Hospice plan implementation. A healthcare professional must balance themselves between effective care and patient comfort, often a difficult tightrope to walk, in order to provide exceptional service.  While difficult, those who take on the challenge of innovating Hospice and healthcare, especially in respect to diabetes and its treatment are bravely pushing forward to establish new methods of both communication and treatment.  At CHIIS, our Agile Innovation methodology has been utilized to increase the satisfaction and well-being of elderly Hoosier patients for several years.  Take a moment to come, explore our site at http://www.hii.iu.edu/ and see what Agile Implementation can do for you!