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Diabetes UK

Diabetes UK. Diabetes and dementia Jackie watts Clinical Advisor. 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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Diabetes UK

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  1. Diabetes UK Diabetes and dementia Jackie watts Clinical Advisor

  2. 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

  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 2 Type 1 24 Type 1 or Type 2?

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

  7. Daily control means achieving a balance Medication Carbohydrate Physical 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. 3.4 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

  10. 3.15 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?

  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. 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

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

  16. 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

  17. 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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