Diabetes and Dementia

In the year 2000, I had two major life events. I got married that year and my grandmother also passed away. I was very close to her, so it was a very challenging time in my life. The bigger challenge though, was dealing with her dementia that hit before she died. My grandmother had been diagnosed with diabetes many years before, but had to control it with insulin and diet changes. Over time, it seemed to get worse. Gradually, she had changes in her skin, changes in vision, and then she became more forgetful. It was more like a foggy mind, and was not nearly as severe as something like Alzheimer's. However, about nine months before her life came to a close she was acting very strange. She was trying to get up and out of bed which was not normal at all. Her neuropathy was so severe, she had to walk with a walker to keep herself upright. She was very feisty; wanting to take off her clothes, and was acting like a kid again. So, our first thought was to check her sugar because we had never seen her like this before. Sure enough, the reading came out at a level of 550. We called the doctor, and later that night we found ourselves in the Emergency Room at Jewish Hospital.

My mom and I sat in the ER with her for what seemed eternity. When the nurse was trying to triage her, she was trying to sit up and was fighting any talk or activity with an IV. She slapped the nurse's hands, and told the doctor he was a real looker! It was hard to keep her calm, but my mother and I both managed to crack a smile. The doctor got a real chuckle, but we knew that something definitely wasn't right. My grandmother was so to speak...."out of her mind". Being from the south, she wouldn't even utter those words to a doctor, and she certainly would never have slapped a nurse. But, her sugar was so high, she was a in a different frame of mind. Something the doctors all labeled as "Dementia".

The sugar reading had increased to 600 within a few hours of her being at the hospital, which one doctor attributed to the stress she was under without really knowing it. She was stressed because they were trying to force an IV in her, while she didn't think it was necessary. They had trouble starting a line on her, so they had to end up going through her neck to get it. Finally, after a few days her sugar was lower, but she was still showing signs of the dementia. The doctors made a joint decision for her to go to a local hospital where the patients were mainly elderly. The hospital is Deaconess Hospital in Cincinnati. Jewish was filling up fast, so they decided to send her to Deaconess, since they had a Hospice unit on the top floor. They weren't telling us that she was dying, but they were concerned about her going into a diabetic coma that would take her out when her sugar spiked again as they were getting her ready for transport.

Once she was at Deaconess, the same doctor paid a visit every day. He was always on top of things, and explained everything to my mom and myself. Dementia was possible in diabetic patients that had either severe low blood sugar or severe high blood sugar. There was a magic number for both. In an online article at www.healthnews.com, Naomi Heroux examines how poor diabetes control can lead to dementia. She examines that heart attack and stroke are not the only risks, that dementia can be as well. The textbook patient would either have really low sugar or really high sugar that would require an emergency room visit. The patients were also typically older, and at that time my grandmother was in her 80's. Dr. Nir Barzilai stated that they really weren't able to prove the cause and effect, but that glucose levels being out of control were a key indicator. Dr. Barzilai points out that unfortunately, insulin adjustments do not repair the situation instanteously, so the patients in this situation have to be monitored very closely. This is the main reason those patients end up making the ER visit. When you see someone doing things that are uncharacteristic and out of control, it's hard to be awake twenty four hours a day to manage it.

Managing a patient with dementia is definitely no easy task. It was already very challenging to take care of my grandmother around the clock. We always had to make sure she got her shots, meals at a certain time, help her to the bathroom etc. These everyday tasks can become challenging when the caretakers all have full-time jobs. I was working full time and going to college full time up until the year this happened, and I was trying to help whenever I could. Once the periods of dementia hit, it was harder to look after her. One example is, she was never able to walk without a walker. However, with the dementia she had increased adrenaline and believed she was fully capable. One night while in the hospital, it was very early in the morning when a nurse found her walking in the hallway without her gown on! It was very quiet and in the middle of the night when this nurse was just doing her routine room check, updating everyone's vitals. She walked out of the patient's room she was working with and was shocked to see this woman with horrible rheumatoid and neuropathy up making her own rounds!

Since I have had this experience with my grandmother, my best advice to anyone who is living with a patient who has dementia, is to know that you don't have to care for them alone. Know that you can enlist the help of others. Being selective is critical, and many families don't want to turn the care of their loved ones over to someone else, but consider your choices carefully. You can get the help you need to care for your loved ones and still live a complete life.