When a patient can no longer express his or her views, close attention needs to be paid to ethical considerations. The Liverpool Integrated Care Pathway for the dying patient is a framework for high quality terminal care during the dying phase, where the comfort of the patient with minimal interventions is paramount. The National Service Framework for Diabetes: standards (DH 2001) and the National Institute for Health and Clinical Excellence (NICE) guidelines for the management of types 1 (NICE 2004) and 2 diabetes (NICE 2002) promote the tight control of blood glucose to prevent the complications of diabetes. This article explores the tension between comfort measures and active treatment.