dementia caused diabetes tips and tricks request

ebplionis

Hi everyone,

Its been a while since I've been on the boards, as always looks like everyone is super busy.  Recently my mothers PCP informed us she has developed diabetes.  She has been pre-diabetic for a while now, but finally crossed over.  The doc seems to think its two things, she is on a new antiphychotic that can spike blood sugar (but we decided its worth keeping her on it because the dosage is right, and works really well!), and she can no longer really control her eating, she forgets if she's eaten and constantly snacks.  She still lives with my father, and gets care-giving but its amazing how little we can control some simple things.  I've changed most foods in the house to a diabetic menu, but I don't want to deprive my dad of things like bread!  I will if I have too, but that seems tough.  So to my question:

Anyone have tips and trick to help manage diabetes in your LO with dementia?  She will be on a pill medication to help, and the doc and I discussed its not worth trying to monitor blood sugar given our current situation.  So I'm down to diet, increased exercise if I can convince her, and any advice from the experts out there.  

Thanks!

King Boo

She should see a diabetes specialist.  Her PCP is most likely unaware of all the up to date management and medication.

There are some once a week injectible meds that can help regulate blood sugar but it depends on the type of diabetes and clinical information.

Locks on cabinets and the fridge may help your dad

M1

ebp, I think your mom's PCP is correct not to worry too much about tight control of her sugars.  She is much more likely to die of low blood sugar than high--that's true for all older diabetics.  There are a number of newer meds (some oral, some injectable) short of insulin that can help, and many do not have a high risk of hypoglycemia (low sugar).  The problem with some of the once-a-week medications is that they do have a pretty significant risk of hypoglycemia, so you have to be careful with those.

This is clearly going to be a case of picking your battles, and it depends on how advanced her dementia is.  I once had a very demented patient who routinely ran sugars in the 400 range but was completely asymptomatic, and it was almost impossible to get people to stop checking her sugar.  What you would routinely do in a non-demented person is not necessarily what applies to our loved ones.

The one number you need to become familiar with is called hemoglobin a1c, and it's measured as a percentage.  Normal range is typically 4-6%, and over 6 qualifies as technically diabetic.  The A1c reflects the average blood sugar over the previous three months (it doesn't change very fast).  Anywhere from 6-8% would be considered reasonable control in your mom I would think.  For every digit that the A1c goes up (ie, from 6 to 7 or from 7 to 8), the risk of vascular complications from diabetes goes up not one-fold but ten-fold.  But these complications typically take years to develop--and your mom may well succumb to something else before she has time to develop such complications.

Good luck, none of this is easy.

sandwichone123

It depends on what your goals are. For my dh, we decided that enjoying *today* was more important than giving up enjoyable things for a longer future. Health care professionals usually advise from the perspective that the only goal possible is to live longer, but with Alz, longer may not be better. My dh does not want to be around when he is no longer "him," so has started putting much more focus on the present and avoiding most health care. He does not want his body around longer than he is.