How to keep diabetes under control in dementia

People with dementia need support with their diabetes management

Dementia in its many forms is considered a new widespread disease. The great forgetting can affect anyone and has an unfortunate interaction with diabetes. Carers must be prepared for this.

Dementia and diabetes are a combination that makes self-treatment almost impossible, because diabetes, especially type 1 diabetes, requires constant monitoring and correction of glucose levels and thus constant action. This is usually too much for people with dementia, they simply forget. The risk of hypoglycaemia and hyperglycaemia increases and secondary diseases threaten.

Maintaining quality of life

The care of people with dementia should be entrusted to professional carers or well-trained family members. The aim is to maintain quality of life and avoid hypoglycaemia. Older people often lose their ability to walk safely and are therefore at increased risk of falling. If this is combined with hypoglycaemia, which usually also clouds consciousness, the risk increases many times over.

Even without dementia, older people often find their diabetes treatment a challenge and a burden. That is why the treatment plan should be as uncomplicated as possible. The primary aim is to avoid hypoglycaemia, and then to prevent secondary diseases. An automated insulin delivery system that is programmed to keep blood sugar within the desired target range can provide great relief.

The older the person being cared for, the higher the target value can be set. If you do not set a target for HbA1c (long-term sugar) or adjust it to the expected life expectancy, this contributes to a higher quality of life, because hypoglycaemia (low blood sugar) will (almost) no longer occur.

Maintaining a balance between quality of life and good blood sugar levels

The first symptoms of dementia can be accompanied by a neglect of diabetes therapy. This presents a major challenge for family doctors, relatives and carers to get people with diabetes and incipient dementia to keep an eye on their blood sugar levels.

As dementia progresses, however, there may come a point at which they have to hand over their diabetes management to others. To prevent mistakes, the operating functions of the aids used, such as insulin pumps, should be switched off for the person concerned. Instead, carers can use monitoring functions to keep an eye on glucose levels on their own mobile phone. It is also possible to set up notifications that will sound an alarm when a certain glucose level is reached. This means that the carer is informed in good time and can take corrective action. However, it all depends on the individual case: if people with dementia tear off the devices and tubes, stop the supply or lose the sensor, insulin pumps and loop systems are no longer an option.

Discussing the desired therapy together

It is almost impossible to predict how dementia will develop and what behaviour will result from it. That is why people with diabetes and their families should talk about treatment options and make arrangements early on. It is a great help for those affected, but also for their families and carers, if a living will has been drawn up and treatment wishes have been recorded at times of full mental presence. These wishes are binding and must be adhered to.