As an experienced hospice nurse, I understand that managing diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) at end of life can be challenging, especially when patients choose to stop taking their diabetic medications or when those medications are no longer an option. In this article, I will provide information on recognizing the signs and symptoms of hyperglycemic crises and outline comfort-based treatment options that align with hospice goals of care.