Caregiver's Grasp of Diabetes to Dementia
Let’s face it, ladies and gentlemen, caregivers have joined the ranks of the first responders, who are also overworked and underappreciated. Regardless of whom they care for, the area of knowledge is still leaps and bounds away from filling in the gaps. We may not be chosen doctors, nurses, attorneys, or therapists by trade, but we need the resources, connections, and knowledge shared so that we may continue to adapt to caring for our loved ones.
A motto that Dr. Jackie Gray works by and understands very well - “Better knowledge, Better care, Better outcomes” describes what millions of caregivers face as they care for their adult parents for various reasons. Jackie is a UK medical doctor, dually accredited as a specialist in Primary Care and Public Health. She is also the Founder of The Carents Room (thecarentsroom.com), an online platform supporting adults looking after parents.
Dr. Jackie has over thirty years of front-line specialist clinical experience in the English National Health Service (NHS), working as a General Practitioner, a Consultant in Public Health Medicine, and a Clinical Lecturer in Epidemiology & Public health. Jackie now works independently as Director of an expert Public Health Consultancy, which helps organizations plan and improve health and care services.
In 2020, compelled by a combination of personal and professional insights, Jackie decided to apply her expertise to fill the gap in support for adults caring for aging parents, a community she calls #carents. She created The Carents Room to highlight the value of carents and give them the information, advice, and connections they need to keep themselves and their loved ones safe and well.
Jackie lives with her husband and her two springer spaniels in North East England, in the shadow of Hadrian’s Wall. I invited Jackie to help shed light on yet another connection to the demise of dementia the world overlooks - diabetes.
When I tried to encourage Mom to eat healthier or perhaps get a bit more exercise, she only responded with her usual eye-roll while saying, “I never said I would die skinny.” It was so funny during her early stages, but it was far from funny as her health worsened and diabetes became a reality.
The world understands bits and pieces about diabetes. Still, just as little is understood about dementia, we do not dig into the details until care regimens dominate our lives to maintain health daily. Soon after they adapt to a new way of life, it is not long after this habit of daily regimen becomes normalized. We learn how far our patterns can be pushed before consequences become too severe to risk. Unless we understand what diabetes means to our system, we cannot truly understand the consequences. This lack of understanding is made clear in the newly named Typed 3 diabetes, a controversial name now linked to Alzheimer’s.
Since May 2017, the Mayo Clinic reported that type 3 diabetes occurs when neurons in the brain become unable to respond to insulin, which is essential for memory and learning. Now researchers believe insulin deficiency is central to the cognitive decline of Alzheimer’s. Similar to the typical treatment response by pharmaceuticals, another multi-institutional clinical study for a new nasal spray is underway rather than education to prevent type 3 diabetes.
So this leaves me to ask, “What is Diabetes, and how does it affect our brain?”
I first needed to understand what insulin is and how our body processes insulin to answer that question. Next, I needed to understand what I may be eating to cause my body to be out of balance or experience low blood sugar. I figured this extra bit of knowledge would help me care for Mom to reduce the amount of medication she was taking and boost her moments of low energy without adding caffeine or junk food.
Insulin is a hormone produced in our pancreas to allow glucose to enter the body’s cells to provide energy. After meals, excess glucose is stored in our liver in the form of glycogen. We store this energy like solar panels store energy from the sun until needed. Our bodies also use insulin to heal wounds, antiaging, bodybuilding, organ preservation, and cardioprotection in acute coronary syndromes.
I knew of diabetes growing up because my paternal grandfather had both legs amputated just above his knees due to diabetic neuropathy or gangrene. After seeing grandpa in a wheelchair, my early understanding of diabetes was there were good and bad kinds, oddly enough. His was the lousy kind since it caused the tissue in his feet to die and become infected. Grandpa died from Type 2 diabetes at 55. When I was 13, I also recalled my Aunt having to give my uncle insulin shots when they visited years ago. I knew then I never wanted to need daily shots. So once again, I assumed he had the bad kind of diabetes.
Later I learned the difference between type 1 and 2 is that type 1 diabetes is a genetic disorder that shows up early in life, whereas type 2 is diet-related and develops over time. Mom and Dad both had type 2 diabetes. Type 2 being the preventable type, I struggled to understand how they choose not to prevent it. At least now, after observing Mom’s daily habits, I finally could see how food can become an addiction. Mom never smoked and rarely drank alcohol, yet she could not see the dangers of addiction from eating the kinds of food that created a habit over time.
With my limited understanding of diabetes, I saw type 1 diabetes as the better type because it was easier to treat and live an entire life. Type 1 means the genetic disorder is an autoimmune disease because the endocrine part of the pancreas cannot produce enough of the hormone insulin. Without the appropriate insulin levels, our blood sugar levels become too high. Young children and adults learning to balance insulin in their bodies may be as simple as using an insulin pen or pump. The pump releases insulin similar to the way our body would naturally.
Over long periods without high blood sugar, the vessels that supply blood to vital organs are damaged, which increases the risk of heart disease, stroke, kidney disease, vision problems, and never problems. Looking back on Mom’s early stages as we laughed at her remarks, we were laughing in the face of father time. Little did we know that accepting that she was not going to die skinny was accepting the trade-off for kidney disease as I write that she is now in stage 3 of kidney failure.
Aside from type 1 & 2, there is also newly named type 3 diabetes, related to the APOE4, which affects the insulin receptors in the brain, causing Alzheimer’s. Most studies have concluded that this newly named type 3 is basically types 2 diabetes. Many in the medical community are unwilling to recognize type 3 diabetes as a medical diagnosis until more research. So far, studies available on Alzheimer’s, brain function, and the deterioration of the brain’s ability to use and metabolize glucose have concluded that the decline in cognitive ability is connected to the decrease in glucose processing by the brain. The tissue in the brain dies, similar to the need for amputation of limbs. Only this deterioration is unseen and unknown until it is too late.
Our brain needs fuel to run efficiently, and that fuel is glucose. Our brains also need vitamins, minerals, and other essential chemicals (proteins, amino acids, and fatty acids). When the body stops growing in height, the brain continues to grow new neuro connections. The link between diabetes and dementia may be better understood when we reexamine the building blocks through insulin and glucose processing. There is also a Type 4 related to insulin resistance in older people who are not overweight or obese. The types continue through Type 5, 6, 7, & 8, mutations of genes in various ages from birth to those in their mid-twenties. One concept remains throughout the descriptions of the types; it is vital to help our systems function efficiently by monitoring our nutritional choices.
Out of a desperate need to avoid becoming my parents, at least living with their adult-onset ailments, I began to pay closer attention to how my body processed sugar many years before I became Mom’s caregiver. I wanted to stop being driven by snacks or meals throughout the day to avoid feeling nauseous or weak. I now understand how my brain processes insulin and other vitamins and minerals. I am given newfound respect for the human body. Listen in to the podcast to hear more of the clinical side from Dr. Jackie Gray.
In the meantime, here is more Food for thought:
1) People with type 2 diabetes may be up to 60 percent more likely to develop Alzheimer's or Vascular Dementia.
2) Women with type 2 diabetes have a higher probability of developing Vascular Dementia than men, especially over the age of 45.
3) Aside from a family history of diabetes, having high blood pressure (hypertension) or being overweight can lead to type 2 diabetes.
4) Chronic health conditions such as depression and polycystic ovarian syndrome (PCOS) can lead to type 2 diabetes.
5) Treatment of type 2 diabetes can slow the progression of dementia but not cure it. Prevention of type 2 diabetes is preferable. Losing 5-10% of your body weight will help restore insulin sensitivity.
6) Exercise 4 times per week for 30 minutes a day can help maintain a healthy weight and metabolism.
7) Eating healthy foods low in saturated fat, rich in protein, and high in fiber will help manage your blood sugar.
8) Monitor your cholesterol levels and take prescribed medications on schedule with regularity.
9) Deal with Stress through practices of yoga and meditation to reduce cravings and food addiction.
10) Quitting smoking to reduce stress on your organs will help your body to process insulin and heal your body better.
11) Get adequate sleep to reduce the effects of chronic stress and improve glucose absorption to curb out-of-control cravings.
12) Enhance your psychological well-being by socializing with others and providing service in your community.
Thank you for joining in and listening today. I hope this episode gave you more food for thought. Until next time, BE PROACTIVE. Take care, everybody.
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Links:
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Music:
Intro: Vacation Time by Khris Paradise
Outro: Misty by Khris Paradise