Diabetes is a complex metabolic disorder that is more common in patients with cancer than in the general population. The ethical dilemmas facing many healthcare professionals in the management of diabetes during the terminal phase of life include the timing of withholding or withdrawing treatment. Communication can also be difficult between healthcare professionals, patients and their families at this time. If the patient’s preferences have not been discussed at an earlier stage in the illness trajectory, mismanagement of diabetes may occur. Local protocols on diabetes management at the end of life have been developed in some areas, but there are no national or standardised guidelines. This can result in fragmented care. This article explores the need for better communication and the development of national guidelines so that the quality of end of life care for patients with diabetes can be improved.