Diabetes is a common comorbidity encountered by people with life-limiting illnesses including cancer, end stage organ failure and neurodegenerative diseases. Its management is crucial to optimise symptom control and level of function for people as they face life-limiting illness.

 Intercurrently, people with diabetes may well have long-term symptoms from the disease itself that magnify the symptoms that are encountered at the end of life. This can include issues such as painful peripheral neuropathies.

 Given the progressive cachexia of almost all life-limiting illnesses, in Type I diabetes there is a case to be made for continuing insulin until the very end of life. By contrast, in Type II diabetes there is often an ability to significantly relax both diet and medications in this population without adding to symptom burden.

 The transition psychologically for many people with diabetes to a more liberal approach to diet is very challenging and needs to be managed collaboratively by general practitioners, the person’s endocrinologist and the palliative care team.