Managing diabetes with dementia: What you need to knowProfessor Graham Stokes, HC-One’s Director of Dementia Care Services, shares his knowledge about the connection between diabetes and dementia as part of Diabetes Awareness Month 2023.

Is there a link between diabetes and dementia?

For many years, it’s been known that type 2 diabetes can lead to a higher risk of strokes and heart disease. However, it is less commonly known that type 2 diabetes can also increase an individual’s risk of developing dementia.

In addition, people living with type 1 diabetes are also at a greater risk of developing dementia than those without diabetes and up to 93% more likely to develop dementia according to one study’s results.

Why might diabetes increase the risk of developing dementia?

There are several hypotheses and reasons why diabetes might lead to dementia.

First is that diabetes can affect the heart, with conditions like heart disease and elevated pressure being associated with strokes, which can in turn lead to dementia.

Secondly, researchers have found that those living with diabetes for less than ten years had deficits in memory function typically associated with the hippocampus (the memory centre of the brain). The study found that those living with diabetes had smaller hippocampal sizes than people without diabetes. In Alzheimer's disease, the hippocampus is among the areas often damaged first. 

Another hypothesis is that diabetes directly causes Alzheimer’s disease, the most common cause of dementia. Alzheimer's disease has even been called ‘type 3 diabetes’ because of the shared molecular and cellular features among diabetes and Alzheimer's. This is because insulin resistance in the body can lead to type 2 diabetes, while insulin resistance in the brain can lead to Alzheimer's disease [54]. A number of studies suggest that adults living with type 2 diabetes have a higher risk of developing Alzheimer’s disease, due to the connection between Alzheimer's disease and high blood sugar levels.

Is there misdiagnosis of dementia in individuals living with diabetes?

Yes, there can be misdiagnosis of dementia in people living with diabetes, particularly for those whose diabetes is not well-managed. Unstable diabetes can trigger hypoglycaemic episodes, which can cause memory and thinking problems that mimic the symptoms of dementia. However, these symptoms can be reversed once blood sugar levels are stabilised, which is why it is so important care staff are aware of the risks and management of diabetes, and are able to differentiate the cause of cognitive problems from those living with dementia.

It's also worth noting that a person may be living with undiagnosed diabetes, therefore a GP visit should always be arranged if a person is showing symptoms of diabetes, or has a family history of the condition.

At HC-One, we are aware that individuals move into our care homes for a host of reasons and often may have at least one or more comorbid ailments. What we mustn’t do is jump to conclusions. For example, if an individual has diabetes and they start to become memory or thinking impaired, we mustn’t assume they have dementia as they are of an older age. Instead, we need to investigate and ensure the right actions are followed by arranging for a GP to come out to the home.

How can I spot the signs of diabetes?

There are a variety of symptoms that someone with diabetes may show, including:
  • Increased need to urinate, especially at night
  • Extreme thirst
  • Feeling more tired than usual
  • Losing weight without trying to
  • Genital itching or thrush
  • Cuts and wounds take longer to heal
  • Blurred eyesight
  • Increased hunger
 
Remember, sometimes the symptoms of diabetes may mimic that of another condition. For example, blurred vision may be mistaken for eyesight deteriorating with age, or weight loss might be assumed to be a result of not eating enough food. Therefore, we shouldn’t make assumptions and need to look at the bigger picture – something we’re very aware of at HC-One.
 
Do diabetics who are diagnosed with dementia need support to manage medication?
 
Yes, those living with both diabetes and dementia require additional assistance and support with administering their medication, as well as assisting them to eat properly so they have a good quality of life.
 
This also applies to people with other conditions, like poor eyesight or arthritis, who require assistance with administering their medication.
 
How can I support a good quality of life for someone with diabetes?
 
It’s all about getting the balance right. You need to not just think about the ailment, but you need to think about the person's quality of life. It’s important to involve the family in discussions and ensure they are briefed on the individual’s care plan.

For example, a person living with diabetes may wish to have a slice of cake with a cup of tea. Rather than say “no that’s not allowed because you are diabetic”, it’s about weighing up what this will add to the individual’s wellbeing and quality of life. It’s about getting the balance right between the two aspects and opening the door for these discussions.
 
If you require further advice on living with dementia and diabetes, please visit:  https://www.alzheimers.org.uk/blog/living-dementia-and-diabetes