Research shows that brain health is promoted by good glucose control, especially if we have diabetes.

 

Diabetes in NZ

  • Diabetes is a group of conditions where people have too much glucose (sugar) in their blood because their body is either not creating enough insulin or the body cannot respond to insulin properly.

  • Out of our country of 5 million, half a million people are estimated to have diabetes.

  • The most common type of diabetes is Type 2 diabetes. In this type of diabetes the cells in a person’s body don’t react properly to the insulin that is present. They become resistant or insensitive so that the insulin cannot do its job, with the result that glucose levels in the blood rise. Over the years, these high glucose levels cause a range of damaging effects around the body. Type 2 diabetes can often be prevented by making healthy food choices and being physically active.

Diabetes and dementia
  • The relationship between diabetes and dementia is complex. We know that having diabetes is associated with a higher risk of developing dementia. One meta-analysis found that people with type 2 diabetes were 56% more likely to develop dementia in later life compared with people without diabetes.
  • We aren’t exactly sure of the mechanism yet, but there are a number of possibilities:
    • People with diabetes may be more likely to have other risk factors that we know are associated with brain health: having high blood pressure, being overweight, being physically inactive, smoking, and having depression.
    • Metabolic changes may damage the brain.
    • Type 2 diabetes increase the risk of strokes and heart attacks, and is particularly linked with an increased risk of vascular dementia.
    • Chronic infection may damage brain cells.
    • Insulin may not be doing what it normally does in the brain: we know that insulin receptors are particularly dense in the areas of the brain that are important for learning and memory.
    • High blood sugar levels seem to increase beta amyloid, which we know builds up in Alzheimers disease
  • It has not been easy to prove that managing diabetes with medication lowers the risk of dementia in later life, but we do know that good diabetes management lowers the risk of strokes and heart attacks, both of which are bad for brain health; and we do know that it lowers the risk of many of the other potential complications of diabetes such as losing the ability to see or having falls because of losing the ability to keep our balance. These are particularly difficult problems for people with dementia to cope with.
  • Experts do agree that preventing diabetes is better than trying to control it, and that if we have diabetes, keeping it under the best control possible is important so long as our glucose levels don’t get too low.
Reducing the risk
  • The great news is that targeting some of the main things that support brain health also reduces the risk of diabetes: we can get two benefits for the price of one! You can find out more about these in other months of the brain health calendar:
    • Maintaining our weight in a healthy range
    • Developing a habit of regular physical exercise
    • Developing an increasingly healthy diet
    • Maintaining our blood pressure and cholesterol levels in a heathy range
  • From mid-life onwards, it is important for everyone to know how their body is doing managing its glucose control. This can be checked with a simple blood test. If “insulin resistance” starts to develop, it is important to manage this as early in our lives as possible because it is much easier to fix when it is mild, before any damage has been done. Lifestyle changes are always part of the management plan.
  • None of this means that it is someone’s ‘fault’ if they develop diabetes: as Diabetes New Zealand says: “Love, don’t judge”.
Supporting people living with dementia and diabetes
  • Managing diabetes can be complex, and involve diet, exercise and medication.
  • In the early stages of dementia you can help by assisting the person to develop simplified routines and reminders. Talking with a community pharmacist about the medication management aids such as electronic medication systems and blister packs might be useful. Talking with the GP or diabetes specialist about digital options for monitoring glucose control such as wearable glucose monitor devices and insulin pumps might also be useful.
  • As a person’s dementia progresses they will need more support to help manage their diabetes.
  • Encourage regular eating of a range of food through the day to help keep blood glucose levels steady, including complex carbohydrate or “high GI” foods like wholemeal bread, rice, and pasta that release their glucose slowly.
  • It can be helpful to let people who are around the person with dementia know what the symptoms and signs of low blood sugar (hypoglycaemia) look like for that particular person because they vary.
  • You can find out more in a booklet from Dementia Australia here.