Diabetes and dementia

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Diabetes UK

• Diabetes and dementia
• Jackie watts
• Clinical Advisor

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How common is diabetes?
3.8 million people with diabetes in UK 90 Type
2 10 Type 1
Nearly 10 65 yrs
630,000 are unaware they have diabetes
One person learns they have diabetes every 3
minutes
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How would you describe diabetes?

• SUGAR
• GLUCOSE INSULIN PANCREAS
• BLOOD

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• Diabetes is a condition which develops when the
  pancreas does not produce enough insulin to
  control blood glucose levels in the body

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Type 1 or Type 2?
24
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Blood glucose targets
Type 2 Type 1
9 8.5
2 hours after eating
7
mmol/l
4
0
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Daily control means achieving a balance
Medication
Carbohydrate
Physical activity
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Long term complications

• Stroke twice the risk
• Cardio-vascular disease 80 deaths
• Retinopathy most common cause blindness working
  age
• Nephropathy most common cause end stage renal
  failure (dialysis)
• Neuropathy 100 amputations per week

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Short-term complications
3.4

• Hyperglycaemia blood glucose levels too
  high
• frequent urination, thirst and tiredness
• if left unattended, Diabetic Ketoacidosis (DKA)
  or Hyperosmolar Hyperglycaemia Syndrome (HHS)
  can occur
• Hypoglycaemia blood glucose levels too low
• sweating, trembling, pallor, anxiety, pounding
  heart, drowsiness, disorientation, seizures, loss
  of consciousness

Blood glucose levels
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Treating a hypo
3.15

• Conscious
• Immediate treatment
• Glass of Lucozade or Non-diet drink
• 3-4 glucose tablets
• 5 sweets
• 100ml fruit juice
• 1 tube of GlucoGel
• NOT chocolate, NOT boiled sweets, NOT a hot
  drink
• Follow-on treatment
• Sandwich
• Cereal bar or bowl of cereal
• Biscuits and milk
• Fruit
• Next meal if due

• Unconscious
• Call an AMBULANCE immediately
• NEVER give food or drink
• Paramedics might administer a glucagon injection
• Think Why hypo?

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Diabetes dementia dilemma?

• Prevalence of diabetes grows with age and
  co-morbidity is common(e.g. dementia, heart
  failure, cardio-vascular disease)
• Many studies suggest people with type 2 diabetes
  may have up to twice the risk of developing
  dementia compared with people without diabetes.
• Dementia may cause difficulties with management
  of diabetes but poorly controlled diabetes can
  also impact on the safety and well-being of
  people with dementia (Biessels et al, 2006).
• Risk of depression is greater in diabetes
• Diagnosis of depression is more challenging in
  dementia

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Potential issues for people with dementia who
develop diabetes www.trend-uk.org

• Developing incontinence as they need to pass
  urine more often but not able to find the toilet
• Increased risk of falls due to more frequent
  visit to the toilet
• Increased confusion if blood glucose levels are
  high and causing dehydration
• Distress if usual diet changed significantly
• Distress if they have pain and are unable to put
  this into words

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Potential issues for people with diabetes who
develop dementia www.trend-uk.org

• Forgetting to take medications regularly
• Forgetting they have taken medication so at risk
  of double dosing
• Forgetting how to do injections
• Unable to make decisions about interpreting blood
  glucose results such as adjusting insulin doses
  or treating hypoglycaemia
• Missing meals and drinks so at risk of low blood
  glucose levels and dehydration
• Forgetting they have eaten and at risk of high
  glucose levels if they eat again

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Dementia or diabetes?
Edna

• New resident to care home
• Has known dementia
• Has recently become incontinent at night
• Appears vague and disorientated
• Sleeps a lot
• Family say she needs eye test

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Diabetes or dementia?
2.19
Edna

• New resident to care home
• Has known diabetes, on insulin, which she
  self-injects
• Sleeps a lot
• Appears very vague and disorientated

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Positive strategies

• Screening diagnosing diabetes early in people
  who already have dementia will ensure they
  receive regular review and management of the risk
  factors that can lead to developing diabetes
  damage
• Agree safe blood glucose targets which aim to
  avoid symptomatic high blood glucose levels
  (hyperglycaemia) but avoid low blood glucose
  levels (hypoglycaemia).
• Ensure adequate carbohydrate intake may need
  change of medication to accommodate eating
  preferences ,or food substitutes for poor eating
• Relief from pain and avoiding hypos can reduce
  agitation / confusion. This can improve eating
  and nutrition

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Solving co-morbidity puzzles

• Co-morbidity a condition of multiple
  pathologies cannot be treated effectively by
  singular pathways/agencies/strategies
• Co-morbidity requires co-operation ,
  co-llaboration co-mmitment between planners
  and providers at all levels

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