Diabetes and dementia

Annat

My mother in law in stage 5 Alzheimers and has lost taste in food and complains about every food for the last six months. She lost weight because of eating issues. Physically she is upright, she can walk, shower, no incontinence, she can do things on her own. But she has very high diabetes like 17.5 to 20 mmol everyday. She has always had high sugar inspite of taking insulin >40 units in the last ten years. But it has never affected her weight... We force her to eat three meals per day,. But recently she is losing more weight than she should be. Her scans of stomach and blood tests all came out normal. Except sugar levels in blood which the doctor if not controlled could affect kidneys. Does dementia cause weight loss…I am wondering if she is last stage or something.

Iris L.

I hope others will chime in with more.  Many PWDs do develop a sweet tooth.  Are you providing sugar-free foods?  

Iris L.

Annat

No, we have exhausted all the foods on earth but she complains and refuses to eat. And dont even think of carbless foods. She only likes rice and it is full of carbs. She drinks milk, avocado, banana. Earlier egg but now she hates egg.  So we have no choice but to giver her rice because we have to feed her with something

Iris L.

If she will accept Ensure, there are different varieties to address various dietary concerns.  Example, high protein, high calorie and others.  You might discuss with a dietician.  Calculate her needed calories per day.  

At a certain point poor appetite is one of the end stage signs.  Have you considered hospice?  The rules for hospice accept failure to thrive with weight loss as an admitting diagnosis.  Then you would have access to more specific resources at this stage of her life.  They do not have to be close to dying.

Iris

Jo C.

Many thoughts come to mind.  Is she taking other meds that can cause foods to taste metallic or otherwise noxious, some meds do this causing our LOs not to want to eat at all as it is so unpleasant.  That is not an unusal occurrence.  You can use Google to look up each of her meds and even Google ask that as a question about each med if it is not on the med side effects reports.  If that is why she has been complaining about food for so long, that can be easily corrected.  Also good to check for teeth or gums that may be causing pain when she eats.

I notice she chooses soft items to eat.  Another issue comes to mind and that is; could she have swallowing difficulty?   That too is not unusual in dementia. One would have  to have a swallow test done as an outpt. which is done by a Registered Dietician to have that checked.  It is not invasive and easily done if that may be a suspician.  Wonder if she ever coughs when eating or perhaps have even a little bit of choking when swallowing.

Also, if she has an infection of ANY kind, that can sometimes affect glucose levels and appetite not wanting nutrition intake. It could be something as simple as a "silent" urinary tract infection that has no complaints of pain or burning but is there anyway.  Diabetics are more susceptible to UTIs, yeast infections as well as other infections including dental caused infections.  Good to have a full UA done in lab with a C/S to rule out a UTI, as at-home dipstick checks are not accurate; there is a high error rate for them.

Is she on long lasting or ultra long lasting insulin or on a short term acting insulin?

https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-treatment/art-20044084

https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631

Does she receive a second med in addition to inusulin?

The diet of course is going to cause a ramping up of her blood sugars simply because rice is an uber-carb food.   Yet, you mention a ten year history of hyperglycemia prior to dementia.  Did she ever have an insulin pump?

Does she have an Endocrinologist as her diabetic specialist ?  If so, that would be a good place to make an appt. to have her checked as to her med control. Also, there are ways to help her diet without having to resort to rice . . . milk shake type diets with nutrition added is sometimes helpful, but since she has been so unstable, do ask for a doctor's order for a Registered Dietician appt., most of them are doing this by phone or on computer due to the pandemic issues. 

An Endocrinologist and Registered Dietician as well as a Nurse Educator have key roles as part of the healthcare team when one has diabetes.  Being that your mother has dementia, this care team would be for your input to get a framework around what is happening.

"Forcing" three meals a day must be difficult.  Would she do better with smaller snack-type offerings multiple times per day instead?  Would she do better with finger food rather than big plate and silverware food?  Does she like thick soups or veggie based soups that she could either choose to eat or drink from a mug?

If she is advancing into end stage dementia, then while it is good to see the diabetic specialist who may be of assistance, sometimes there is nothing we are able to do except be supportive for comfort measures.  IF (and one must rule out all else) that is happening, then one can opt to choose Hospice for end of life support and they can be extremely helpful to both the patient and the family.

As said, I had a lot of thoughts flitting through my mind.

Let us know how it is going, we will be thinking of you and send warm thoughts and best wishes your way.

J.

Annat

Thank you for your detailed reply. She is on metmorphin also and takes memantine. Memantine could probably make mouth taste weird. 

She does not like any food other than some rice and yogurt. No soup, no meat, fish, no snack types. She hunts for sugar, juice, gingerale and when she didnt find sugar, she emptied a jar of honey. 

She eats very slowly in the last six months and she chokes sometimes.

About hospice- eventhough she appears to be losing weight and looks weak, she is active, she can walk, independent. And she is verbally aggressive, combative, yells at us saying the food is cooked bad,  giving her 3 month old food and stealing her clothes saga going on for years..etc., so I dont know if she looks or acts the part of a hospice candidate. 

Plus in social settings, she is very different and very active and participates and noone would believe she is sick..

We are tired of cooking different types of meals 3 times a day for several days of the week. Its mentally very draining..Because after work and taking care of my young children and finding time to cook these variety meals, all we get is curse and insult. 

And plus when she refuses to eat and loses weight, there are comments from siblings about give her this, give her that and constant monitoring of her appearance, which drives us nuts..what more can we do..its very frustrating.. 

sophirolr

It's sad to hear that. Many PWDs do develop a sweet tooth

aannaa

Diabetes is really very scary. I have been diagnosed recently, and I am pretty depressed about it, and I am looking for some ways to get better. I plan to buy trulicity online https://www.canadadrugsdirect.com/products/trulicity as my blood sugar level rises from time to time. I was told that it is really good and working. What do you think about it? Any experience? If not, when I try it, I will share my thoughts on it. Good doctors and plus taking care of your diet is already a big step to success!

harshedbuzz

Annat-

Diabetes is a beast. Dealing with diabetes in the context of dementia's impact on diet and exercise is very difficult.

Food preferences can change dramatically fairly early on. My dad used to take us out to an ice cream parlor every Friday night after he did payroll at a business he owned when I was a kid. We'd get sundaes and he'd order coffee. If he was feeling festive, he might order a club sandwich, but I never saw him eat ice cream (or any other dessert) until he developed dementia. And then they became his favorite things.

Weight loss is typical in the latter stages of the disease. Sometimes there is no interest in food or meals are forgotten entirely. Sometimes appetites wane and supplements like Ensure need to be added. In the very late stages, it was explained to me, the body may not be absorbing what is eaten and it just passes through the body. 

Swallowing and chewing are controlled by the brain and damage can impact that. Sometimes when a PWD is transitioned to a soft diet or thickened liquids they aren't as interested in the newer version of their favorites.

A swallow assessment is a good idea. Ours was done by a SLP who specialized in feeding in the elderly. Her concern about rice would be aspiration-- fluffy white rice is very easy to inhale down the "wrong pipe".

That said, if rice is what she'll eat have you tried cooling a reheating it? Evidently, this can reduce the impact of white rice on blood sugar. I thought this was nonsense when I first heard it, but the NIH says otherwise.

Effect of cooling of cooked white rice on resistant starch content and glycemic response - PubMed (nih.gov)


HB