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Diabetes and dementia
My mother in law in stage 5 Alzheimers and has lost taste in
food and complains about every food for the last six months. She lost weight
because of eating issues. Physically she is upright, she can walk, shower, no
incontinence, she can do things on her own. But she has very high diabetes like
17.5 to 20 mmol everyday. She has always had high sugar inspite of taking
insulin >40 units in the last ten years. But it has never affected her
weight... We force her to eat three meals per day,. But recently she is losing more
weight than she should be. Her scans of stomach and blood tests all came out
normal. Except sugar levels in blood which the doctor if not controlled could
affect kidneys. Does dementia cause weight loss…I am wondering if she is last stage or something.
I hope others will chime in with more. Many PWDs do develop a sweet tooth. Are you providing sugar-free foods?
If she will accept Ensure, there are different varieties to address various dietary concerns. Example, high protein, high calorie and others. You might discuss with a dietician. Calculate her needed calories per day.
At a certain point poor appetite is one of the end stage signs. Have you considered hospice? The rules for hospice accept failure to thrive with weight loss as an admitting diagnosis. Then you would have access to more specific resources at this stage of her life. They do not have to be close to dying.
Many thoughts come to mind. Is she taking other meds that can cause foods to taste metallic or otherwise noxious, some meds do this causing our LOs not to want to eat at all as it is so unpleasant. That is not an unusal occurrence. You can use Google to look up each of her meds and even Google ask that as a question about each med if it is not on the med side effects reports. If that is why she has been complaining about food for so long, that can be easily corrected. Also good to check for teeth or gums that may be causing pain when she eats.
I notice she chooses soft items to eat. Another issue comes to mind and that is; could she have swallowing difficulty? That too is not unusual in dementia. One would have to have a swallow test done as an outpt. which is done by a Registered Dietician to have that checked. It is not invasive and easily done if that may be a suspician. Wonder if she ever coughs when eating or perhaps have even a little bit of choking when swallowing.
Also, if she has an infection of ANY kind, that can sometimes affect glucose levels and appetite not wanting nutrition intake. It could be something as simple as a "silent" urinary tract infection that has no complaints of pain or burning but is there anyway. Diabetics are more susceptible to UTIs, yeast infections as well as other infections including dental caused infections. Good to have a full UA done in lab with a C/S to rule out a UTI, as at-home dipstick checks are not accurate; there is a high error rate for them.
Is she on long lasting or ultra long lasting insulin or on a short term acting insulin?
Does she receive a second med in addition to inusulin?
The diet of course is going to cause a ramping up of her blood sugars simply because rice is an uber-carb food. Yet, you mention a ten year history of hyperglycemia prior to dementia. Did she ever have an insulin pump?
Does she have an Endocrinologist as her diabetic specialist ? If so, that would be a good place to make an appt. to have her checked as to her med control. Also, there are ways to help her diet without having to resort to rice . . . milk shake type diets with nutrition added is sometimes helpful, but since she has been so unstable, do ask for a doctor's order for a Registered Dietician appt., most of them are doing this by phone or on computer due to the pandemic issues.
An Endocrinologist and Registered Dietician as well as a Nurse Educator have key roles as part of the healthcare team when one has diabetes. Being that your mother has dementia, this care team would be for your input to get a framework around what is happening.
"Forcing" three meals a day must be difficult. Would she do better with smaller snack-type offerings multiple times per day instead? Would she do better with finger food rather than big plate and silverware food? Does she like thick soups or veggie based soups that she could either choose to eat or drink from a mug?
If she is advancing into end stage dementia, then while it is good to see the diabetic specialist who may be of assistance, sometimes there is nothing we are able to do except be supportive for comfort measures. IF (and one must rule out all else) that is happening, then one can opt to choose Hospice for end of life support and they can be extremely helpful to both the patient and the family.
As said, I had a lot of thoughts flitting through my mind.
Let us know how it is going, we will be thinking of you and send warm thoughts and best wishes your way.
Thank you for your detailed reply. She is on metmorphin also and takes memantine. Memantine could probably make mouth taste weird.
She does not like any food other than some rice and yogurt. No soup, no meat, fish, no snack types. She hunts for sugar, juice, gingerale and when she didnt find sugar, she emptied a jar of honey.
She eats very slowly in the last six months and she chokes sometimes.
About hospice- eventhough she appears to be losing weight and looks weak, she is active, she can walk, independent. And she is verbally aggressive, combative, yells at us saying the food is cooked bad, giving her 3 month old food and stealing her clothes saga going on for years..etc., so I dont know if she looks or acts the part of a hospice candidate.
Plus in social settings, she is very different and very active and participates and noone would believe she is sick..
We are tired of cooking different types of meals 3 times a day for several days of the week. Its mentally very draining..Because after work and taking care of my young children and finding time to cook these variety meals, all we get is curse and insult.
And plus when she refuses to eat and loses weight, there are comments from siblings about give her this, give her that and constant monitoring of her appearance, which drives us nuts..what more can we do..its very frustrating..