1. Diabetes and dementia Jackie watts Clinical Advisor Diabetes UK

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

3. How would you describe diabetes? SUGAR GLUCOSE INSULIN PANCREAS BLOOD

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

5. Type 1 or Type 2? Type 1 Type 2 24

6. Blood glucose targets 4 9 8.5 7 0 2 hours after eating Type 2 Type 1 mmol/l

7. Daily control means achieving a balance Medication CarbohydratePhysical activity

8. 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

9. Short-term complications 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 3.4

10. Treating a hypo 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? 3.15

11. 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

12. 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

13. 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

14. Edna Dementia or diabetes? 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

15. Edna Diabetes or dementia? New resident to care home Has known diabetes, on insulin, which she self-injects Sleeps a lot Appears very vague and disorientated 2.19

17. 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

18. 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