if a person with type 1 has some cognitive impairment like many elderly people do, but they are still living independently, what would be the best treatment for them? what treatment would be the most forgiving of mistakes? i’m thinking that a bernstein low carb plan would be the first step along with a one shot a day basal, and then maybe affrezza to correct post meal highs.
Sounds like a situation in which home health support might be very effective. Is this an option?
that’s probably one of the worst scenarios for safety. If they had a caregiver, then there are a lot more options. I’d say about the only thing off the top of my head that comes to mind is LOW CARB, and don’t shoot for tight control by any means.
Just living alone can be anxiety-provoking for a fully aware insulin dependent person. I’ve often thought how could I cope with my bg’s if I were blind and/or mentally impaired.
Off topic (sorry to the OP!), but how would being blind impair your ability to manage your diabetes? Being blind and being cognitively impaired are completely different! Most people fear that blindness will impose barriers that are more imagined than real.
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I’m not even going to explain how. it should be self-evident.
I don’t think it’s correct to claim that discussing blindness is “OT” in a discusion about impairment. I consider blindness one heck of an impairment. I’d consider being totally deaf an impairment. I’d consider being a quadriplegic an impairment…
To me it’s not self-evident. I’ve lived with Type 1 diabetes for the past 24 years and blindness for longer than that and I manage my diabetes and all other aspects of my life independently. I’ve worked with hundreds of children and adults who are blind over the past 10 years, some who also live with diabetes independently. I think that many people build notions about blindness on assumptions of what they believe living life with little or no vision “must be like” without basing those ideas in reality.
[quote]I don’t think it’s correct to claim that discussing blindness is “OT” in
a discusion about impairment. I consider blindness one heck of an
impairment. I’d consider being totally deaf an impairment. I’d
consider being a quadriplegic an impairment…[/quote]
The OP was asking about cognitive impairment, not blindness. I didn’t say blindness wasn’t an impairment. It is an impairment liviing in a world where everything is designed for people with good vision. It means we need to learn new techniques, do a bit of creative problem-solving, and work a bit harder. But in terms of diabetes management (and most other aspects of life…), once someone has found ways to access the information they need and perform the tasks that need to be done, there is no reason that blindness should have any impact on their ability to manage blood sugars competently.
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A very good friend of mine who I have unfortunately lost touch with used to always tell me that I didn’t need my vision as much as I always seemed to think I did.
One of the things I learned from my time spent with her was that the “sighted” tend to assume that the world will end if they ever lose the ability to see. By contrast, to her it was just a fact of life that needed to be dealt with but didn’t … control (?) her.
In other words, I could understand, at least from the “neck up”, that she had a point.
I think that many people look at disabilities, have no idea how something would be accomplished without a particular sense or function or ability, and rather than thinking of possible solutions they just assume it can’t be done without depending on an able-bodied person. Unfortunately, most people never approach someone who has a disability to ask, and so these assumptions percolate through society until they are practically viewed as facts, even though they’re not based in reality.
My dear friend became unable to manage her insulin dosing (she is T2). It became so bad that the doctor had to take insulin away from her and recommend to her daughter that she be placed in a nursing home. She is relieved now not to have to balance food and insulin herself; she is not really cognitively impaired but was worn out with the extra effort involved in looking after herself. She is 85 now, and this solution has worked well for everyone.
my question is just a hypothetical one. the point at which someone cannot be independent anymore is often a fuzzy one. i can be very forgetful and i am only 50! but i want to be as independent for as long as i can, and that includes the possibility of living with my children, but being independent pretty much in that context. my mom lived with me the last 10 years of her life in her own addition to our house, and she was very independent until the last month and a half of her life. she drove herself everywhere, even to her chemo appointments. she kept meticulous blood sugar records as a totally insulin dependent diabetic- she was lucky she had that in her personality!! just like every cent was accounted for in her check book. near the end when the cancer was metastasizing to her brain, she would lose her balance walking in the mall by herself. she knew when to stop driving her big old turbo drive subaru suv. she was trying to prepare me for her end, but it was too much of a shock.
i’m drifting off topic, but i have it in mind to discover some way to know what is an adequate amount of pain medication for unconscious people in hospice. when my mom was at our home getting periodic visits from the hospice nurse, we had to guess when to give her morphine under her tongue. the nurse told us that if she grimaced or groaned, that was the sign to give morphine. but i feel this method is too imprecise. if we could measure other indications of pain, like maybe pulse or skin temp fluctuation, or something like that, maybe we could reduce the suffering of those in their last days who can’t tell us what they need. anyway, that’s something i am thinking about.
Several years ago I took a fairly intensive course on autmentative and alternative communication. It was meant primarily for teachers working with children who, due to a cognitive or physical disability, were unable to communicate effectively with speech to varying degrees. One of the things that our professor advised us to do was that, if we knew that we were going to be in hospital unable to communicate (such as in the ICU after surgery), that we come up with a communication system prior to the event. There are some AAC methods that are suitable for those with severe cognitive disabilities, and other systems that are practically a language in themselves and have a steep learning curve.
I thought it wasn’t a bad idea. In fact, my jaw has a tendency to dislocate at random times when I yawn or just open it wrong. Each time this happens, I invariably end up at emergency and they have to knock me out to get it back in place. Every time this happens I’m unable to talk and thus can’t answer much more than yes or no questions. I’ve always had someone else with me at the hospital, but the last time this happened even the person with me didn’t know the answers to everything they were asking (such as medical history), and I resorted to typing answers on my iPhone.
I don’t think it’s a bad idea to think about these things ahead of time. And, while home health care is one option and is invaluable for some, it’s definitely not the only answer. My parents are still young, so I don’t have much experience caring for older adults, though I do have experience working with older adults with visual impairments, some of whom also had cognitive challenges. I think solutions that might work will vary a lot depending on the type of cogntiive impairment (short- or long-term memory, reasoning skills, basic environmental awareness, etc.). There are lots of technologies and devices designed for people with cognitive challenges. There are apps and watches that can be set with text or audio reminders to take medication at certain times or intervals; glucose meters that provide non-numerical indicators that BG is high or low (through colour, light, or sound); there are cases for safely storing pre-measured insulin syringes and devices that make injecting as simple as putting the syringe in the device and pressing a button; there are pill dispensers that have built-in calendars and clocks so that they spit out the current dose of medication while keeping the rest inaccessible; there are, of course, CGMs that can protect from highs and lows and send glucose readings to be monitored remotely by family or friends; as you noted, there are diets that make extreme fluctuations in blood sugar far less likely.
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Its a pretty wide open question…
I suppose the main determining factors would be their level of impairment… can they reliably follow a simple set of instructions without significant risk of errors?
If so your lantus and afrezza suggestion seems like a reasonable starting point… with some strict rules to follow, maybe something like " test at 10 am, 3 pm and bedtime… if your bg is above X, inhale one cartridge" or something like that…
But again it depends entirely on their level of comprehension and ability to follow instructions…
There’s quite a bit of room to simplify an insulin regimen… but if someone can’t rationally make decisions for themselves, OR reliably follow the instructions of someone who can lay it out for them reasonably well… then they probably can’t be living alone I would think
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in borderline cases where we don’t know how much a person can handle, i guess they would need to be monitored while they were living independently. when a dangerous event happened, that could be caught thru monitoring, and a level of independence would need to be taken away. for example, you find that an elderly family member is starting to have fender benders (maybe at the first fender bender you just start riding with them a few times to see if their driving skills have deteriorated). if you see their skills have deteriorated, they shouldn’t be driving and they need to give up their keys, but an alternate form of independent travel needs to be found for them. like calling county sponsored shuttles or using public transport like the bus or family members driving them where they need to go. preserving as much independence as possible is important to quality of life.
wow, these are great ideas! especially the one above. i remember once my mom forgot that she had already taken her insulin, so she took a double dose. we had to call the ambulance.
i lived in taiwan for 7 years and my husband is chinese. their culture emphasizes that family and friends need to help each other- that this is critically important and should be done even when there is some sacrifice/inconvenience. they don’t glorify the hero who goes out alone on a quest. their quest stories are always about friends going out together. i mention this because i think generally speaking in american culture we give too little thought to the fact that we really need other people’s help in trying times. if we have done well financially, yes, maybe we can just buy that help. but for most people, especially when they get old, they are going to need help. i am hopefully years away from this, but i wish there were regional groups where people came together to help each other in old age. the groups would be multi age and would include family members and non-family members (because even family members need a break in difficult situations). i think this situation used to be covered by church groups? but i am an agnostic, so that wouldn’t help me. older people can have such a better quality of life with even just a little bit of extra help. when my mom lived with me, i would go to the pharmacy for her or shop for her when she was feeling weak, but a lot of the time she did it herself. most importantly, people who can’t get out of the house that much because of health problems need human contact. as america ages, i hope to see something like regional, multiage, mutual-aid groups develop in the culture. i am a little lucky because i have chinese family members who go all out to help each other- and i have helped them many times as well.
jen i love these ideas and will research them more on my own, but my concern is different in that i am talking about people in hospice who are unconscious and cannot communicate, but are in pain. actually, they may be conscious, but they have no way to show it. they are immobilized. what i really hope for is that suffering can be cut short through physician assisted suicide. but until that is a wider reality, i want to decrease suffering in those waiting to die who are absolutely unable to communicate their level of pain.
after i wrote the above, i was wondering if unconscious people even feel pain, and i found this article:
http://news.sciencemag.org/health/2008/10/unconscious-brain-still-registers-pain
I guess I’m not understanding your point within the context of this thread… Amino acids are needed for exactly what?
As a physician, I know a great deal about amino acids and their role in physiology, metabolism, etc., thank you very much. And “only raw will work”? Only raw will work for what exactly? What I’m asking is what point you are trying to make about amino acids in regards to the topic of this thread: “Best treatment for a cognitively impaired Type 1”? Are you saying that cognitive impairment and/or diabetes can be effectively treated or reversed by eating raw foods containing amino acids? Please clarify.
Please disregard the two posts immediately preceding this one. They were written in reply to a rather strange post that has since been removed. Thank you.
There is apple software that can transmit dexcom readings directly to your phone so you can monitor and be alerted during low BG levels.Share software
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