There is a potential domino effect of accidents, conditions, and problems that can occur when individuals have dementia and then develop diabetes and those who have diabetes and develop dementia. “Diabetes and Dementia: Guidance on Practical Management,” published by the British Institute of Diabetes for Older People, identified the cascade of problems that might occur.

For people who have dementia, then develop diabetes:
■ They may develop incontinence as osmotic diuresis—increased urination due to the presence of certain substances in the fluid filtered by the kidney—makes them need to urinate more frequently.

■ They are at increased risk for falling because of their need to rush to the toilet to urinate frequently.

■ They may experience increased confusion if high blood glucose levels cause dehydration.

■ They may feel distressed if their diet is changed significantly.

■ If they have diabetic neuropathy or other pain, they may act out by wandering, rocking, crying, or lashing out if they can’t verbally express their discomfort.

For people who have diabetes, then develop dementia:
■ They may start forgetting to take medications regularly or may forget that they already took medication and take it again.

■ They may forget how to administer injections.

■ They may be unable to understand blood glucose readings/results and/or make decisions about things such as adjusting insulin doses.

■ They may miss meals or forget to eat or drink, putting themselves at risk for low blood glucose levels and dehydration.

■ They may forget they ate and eat again, putting themselves at risk of high glucose levels.