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Teachable Moment
Less Is More
March 2015

Sense and Nonsense of Treatment of Comorbid Diseases in Terminally Ill Patients

Author Affiliations
  • 1Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
  • 2Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
JAMA Intern Med. 2015;175(3):346. doi:10.1001/jamainternmed.2014.7592

A 69-year-old woman was diagnosed as having metastatic pancreatic cancer. She had a history of type 2 diabetes mellitus, which was diagnosed 7 years earlier. Initially, her diabetes was controlled by strict adherence to a healthy lifestyle. For example, she had stopped eating ice cream, which she was very fond of. Two years prior to the cancer diagnosis, she had started metformin therapy, and hemoglobin A1c level measurements of 6.8% were achieved.

She was treated with palliative chemotherapy, and during each cycle she received dexamethasone to reduce associated nausea. During the first 2 cycles, her blood glucose level rose as high as 288 mg/dL (to convert to millimoles per liter, multiply by 0.0555), for which she received short-acting insulin.

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