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Caregiver Series: Caring for Diabetes and Dementia: A Unique Challenge

POSTED BY: Florida Hospital

A staggering 100 million Americans — nearly one in three of us — have diabetes or prediabetes. The risk increase as we age. Diabetes results in poor regulation of the level of sugar, or glucose, in the body. High levels of glucose can damage certain tissues of the body and create dangerous dysfunction of key organs such as the heart, kidneys, and eyes. We are now learning more about how diabetes impacts the normal function of the brain.

The brain is especially sensitive to the effects of diabetes. People with diabetes are at risk of high blood pressure, and in turn, high blood pressure can lead to strokes. Like a heart attack, where blood flow is blocked to heart tissue, strokes occur when the blood carrying nutrients and oxygen is interrupted. In some cases, these “brain attacks” lead to permanent loss of strength or inability to speak. In some cases, the strokes can lead to damage in the thinking parts of the brain. When this happens, it is called “vascular dementia.” It is this combination of dementia and diabetes that is particularly difficult.

When someone has dementia, their normal intellectual abilities decline over time. Having diabetes requires an individual to be careful with what they eat and drink, and monitor their exercise all while eating and taking medications on a regular schedule. If dementia has set in, and the ability to remember to take medications, follow instructions, and keep track of what and when to eat is affected, patients face great challenges without help.

At the Centre for Senior Health, Dr. Rosemary Laird likes to partner with colleagues in The Florida Diabetes & Endocrine Center and the Florida Hospital Diabetes, Obesity and Endocrinology Institute to offer patients and their caregivers specialists in all aspects of diabetes treatment.

Dr. Laird notes the special circumstances caused by the presence of both dementia and diabetes are another reminder that your care team should include experienced specialists.
“Professionals who can help a patient and/or family adapt to the range of diabetic and dementia-specific needs can make a big difference for patients and their caregivers,” she says

Erica Hechler, MS, RD, CDE, LD, CCP, is a registered dietitian and certified diabetes educator and health coach at the Florida Hospital Obesity, Diabetes and Endocrinology Institute. Her dietary advice can help patients and their family caregivers manage diabetes well, with special emphasis on strategies to follow as dementia progresses. 

Making a diabetes diet plan

Hechler said there are four basic areas of diabetes self-management. But basic does not mean “easy” — the Florida Hospital Diabetes Institute is experienced at helping patients put these guidelines into real practice.

  1. Follow an eating plan that cuts down on carbs, focuses on lean proteins like fish and turkey and incorporates plenty of vegetables, especially leafy greens.
  2. Follow an exercise plan that includes aerobic exercise and strength conditioning.
  3. Take appropriate diabetes management medications.
  4. Reduce your stress, which can increase your blood sugar.

She also recommends keeping on top of your preventative visits, including seeing your doctor four times a year, getting an annual foot check and having your eyes examined once a year.

And remember that your knowledge should change with your circumstances. Starting a new medicine or changing up your eating plan are both good reasons to brush up on your diabetes education.

Hechler also adds that this dietary advice, though crafted specifically for someone with the illness, really applies to pretty much anyone.

“The diabetes diet is one of the healthiest diets out here,” she says.

And if you would like individualized diabetes diet meal planning help, this is the Florida Hospital Diabetes, Obesity and Endocrinology Institute’s specialty.

Eating healthy with dementia

In the early stage of Dementia, patients will usually be able to follow usual diabetic diet guidelines. As the dementia progresses, problems with thinking and memory may limit the foods they can or will eat regularly. This can greatly complicate a caregiver’s efforts at helping their loved one eat enough food, let alone maintain a healthy diet. Sadly, as the course of dementia progresses towards its unfortunate and inescapable late stage, it is critical to be fully engaged with the medical team so the goals of diabetic care management are appropriately adjusted. 

For patients with diabetes who have a long life expectancy, the goal is tight glucose control so the long-term damage to the body’s organs is limited. As dementia progresses and life expectancy shortens it is less important to limit the long-term effects. Elevated blood glucose levels may be more acceptable, and strict rules limiting fruit and sugar in the diet may be loosened.

Here are some tips to help caregivers manage their loved one’s nutrition in later stages of dementia:

  • Offer a balanced plate with nutrient-dense healthy fats such as nut butters and avocados. They are also packed with calories, so your loved one doesn’t need to eat a lot. Other good choices include:
  • Smoothies with protein. Smoothies are a great way to incorporate high-fiber foods, like vegetables and many fruits, into a diet. Ideas for the protein source include protein powder, peanut butter or nut butter.
  • Oatmeal with nut butter
  • Omelets or egg scrambles
  • Tuna Casserole with noodles, cheese and garbanzos
  • Greek yogurt parfait

What these foods have in common is high-quality carbs and proteins in a nutrient-dense setting. Even if your loved one doesn’t finish their plate, they’ve still consumed plenty of calories along with their nutrients.

  • Cut back on empty-calorie refined sugars like cake and cookies, and consider replacing them with Fruit. (Remember in later stages the limits on fruit can probably be lifted. Check with your doctor.)
  • Ill-fitting dentures often raise problems with chewing. Consider food that is soft, in small chunks and easier to swallow.
  • Adaptive eating devices can allow a person with dementia to eat on their own, which will help them maintain their independence and eat more. Examples include large-handled spoons, bowls and plates with higher rims and plates with suction cups on the bottom. In later stages of dementia, finger foods and using straws can be helpful.

Avoiding caregiver burnout

It’s easy to see how managing diabetes and dementia can lead to burnout among caregivers.

“Caregivers report very high levels of stress because of the time and energy to take care of their loved one because of the degree of care that’s involved,” she says. “We encourage caregivers to step back, recognize the symptoms of stress and take time to assess their mental health.”

Dr. Laird is also an expert on caregiver burnout, having coauthored the book, “Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.”

She has some advice to help caregivers maintain their own health:

  • Take Your Oxygen First! If you don’t take time for self-care, schedule regular breaks and ask family members for help you won’t be much good to those who rely on you.
  • Keep up with your own medical appointments; consider including a therapist to talk
  • about your feelings as a caregiver.
  • Incorporate exercise into your routine. This releases stress-reducing chemicals and helps you manage your weight.
  • Consider joining a local support group for caregivers with dementia. Ask your caregiver’s provider about support near you, or consider visiting the Alzheimer’s Association for additional resources.
  • Remember that changes in your loved one’s condition are a natural part of their illness and aren’t your fault.

Rosemary Laird, MD, MHSA is a member of Florida Hospital Medical Group. She is a board-certified Geriatrician with more than 20 years of experience helping patients and families navigate the joys and challenges of life’s later stages. In 2013 she was named The American Geriatrics Society Clinician of the Year.

Her team at Centre for Senior Health in Winter Park is focused on providing specialty geriatrics consultations and coordinating care with your primary care provider and/or other specialists.

To reach Dr. Laird’s Winter Park practice, call (855) 303-DOCS. Click here to read more from Dr. Laird's Caregiver Series