Type 1 diabetes, vascular dementia - stage 8.

I have told bits and pieces of my DW's story. I will tell her story now for the chance that we may be able to help others in similar circumstances. She developed type 1 diabetes when she was 8 years old. In 2012 (age 56) she suddenly developed dizziness and lost excecutive function. She underwent physical therapy and her dizziness improved but her executive function did not. In 2015, she had another sudden decline and lost even more executive function. In 2016 she was diagnosed with vascular dementia. I retired to care for her. In 2016 we met with our attorney and changed all our documents to reflect this new reality. My DW added a clause to her advanced directive that stated her insulin should be stopped when her dementia became severe. I asked her what criteria I should use to stop her insulin. She told me that when she no longer knew who I was, she wanted the insulin stopped. She continued to decline in a stairstep fashion over the next 9 years. In January 2024, she became increasingly agitated and we had to treat her with seroquel and citalopram. In December 2024, I placed her in a MC facility. She received excellent care and I visited her nearly every day. In March 2025, she began to not remember who I was. Over the ensuing months I began to feel increasing guilt for not honoring her wishes. I procrastinated, hoping that something else would cause her death and I would not have to stop her insulin. I discussed the situation with our kids and my DW's sisters. I decided to proceed with stopping her insulin. I met with her palliative care doctor and hospice was consulted. I met with the director and nurse of the MC facility as well as hospice. We stopped her insulin on the evening of 8/25. Hospice started her on a low dose of morphine. She became unresponsive on 8/27 and died on the morning of 8/28/25. My wife was a solid stage 6. She never experienced a single day of stage 7 and for that I am extremely grateful. She has been my girlfriend since 1978 and wife since 1979. I am sad but relieved. Some of you may not agree with our approach and that is ok. I share our story with the hope that it will help someone. I am glad we had an advanced directive and I am glad we consulted a palliative care doctor. I am glad my wife and I had very difficult discussions early in the course of her dementia so I would know how to best help honor her wishes.