Managing Type 2 Diabetes When You Have Early-Stage Alzheimer's

Management of both type 2 diabetes and Alzheimer’s can pose unique challenges, says Marc Jaffe, MD, MPH, an endocrinologist who specializes in diabetes care at Kaiser Permanente in San Francisco. “But I believe with the right tools, support, and simplified routines, people can continue to live safely and stay healthy.”

Below, learn some basics for navigating these two conditions successfully.

• Inability to use the sugar in your blood as fuel
• Chemical message interruptions
• Buildup of lesions (like amyloid-beta plaques)
• Damaged blood vessels that carry oxygen to the brain
• Brain cell damage

High or low blood sugar levels can look similar to some Alzheimer’s symptoms. “Confusion, irritability, sleepiness, or unusual behavior may stem from either condition,” says Dr. Jaffe.

Worsening Alzheimer’s symptoms aren’t as serious as very low or high blood sugar levels, says James “Trey” Bateman, MD, a behavioral neurologist at the VCU Parkinson’s and Movement Disorders Center and the chair of VCU Health Alzheimer’s and Cognitive Disorders Clinic in Richmond, Virginia. But it’s vital to recognize a blood sugar emergency, because treatment can reverse your symptoms and prevent more brain injury, says Dr. Bateman.

Low blood sugar (hypoglycemia) can be an emergency requiring quick treatment, and symptoms usually improve within minutes of consuming sugar, says Jaffe. “[And] high blood sugar, or hyperglycemia, if not recognized and treated, can lead to dehydration, infection, and hospitalization.”

But Alzheimer’s symptoms fluctuate more slowly and don’t usually resolve quickly after eating or drinking, says Jaffe. “I recommend patients, families, and caregivers learn the signs of both conditions and use glucose monitors to help clarify what’s happening.”

Medication Changes

“Switch from multiple daily medications to once-daily or once-weekly medications when possible,” says Jaffe, who also recommends long-acting insulin instead of several short-acting doses if you still need insulin.

Medication Management

Even after your provider has adjusted your medications, your dosing schedule may still feel complicated. Dr. Majety recommends these tips to manage your meds:

• Use blister packs or weekly pill organizers.
• Try timed dispensing devices.
• Keep all medications in one consistent storage spot.
• Avoid keeping medication bottles in many locations.

Simplified Blood Glucose Monitoring

“A continuous glucose monitor (CGM) is often much easier than finger sticks, because it provides automatic readings, alerts signal lows or highs, and caregivers can receive remote data,” says Jaffe. But if CGM isn’t an option, you can still decrease your blood sugar checks to once a day and as needed if your provider says it’s okay.

Blood Glucose and A1C Goals

When you have both diabetes and Alzheimer’s, the goal shifts from “tight control” to “safe control,” says Jaffe. For many people with type 2 diabetes and early Alzheimer’s, a good A1C, or HbA1C, goal is between 7.5 and 8.5 percent, says Jaffe, who adds that this range:

• Reduces the risk of dangerously low blood sugar
• Lessens treatment burden
• Helps prevent emergency department visits and hospitalizations
• Protects long-term health
• Lowers the risk of many infections

Nutrition

To stay safe with diabetes and Alzheimer’s, consider adopting the following strategies in your daily life.

• When in doubt, check your glucose. If you feel symptoms that could signal low or high blood glucose, check your blood sugar level.

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• Stay hydrated. High blood sugar causes dehydration, and with Alzheimer’s, you may forget to drink, so set alarms or ask a loved one to remind you to drink water throughout the day.

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• Keep a hypoglycemia emergency kit readily available. Your kit should include items to raise your blood sugar fast, like juice, regular soda, sugar, honey, syrup, hard candy, or glucose tablets.

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   It should also have a glucagon rescue medication (nasal or injection), says Jaffe, which caregivers and family should know when and how to use.
• Build predictable routines. Consistency in meals, medications, and sleep reduces both blood sugar swings and Alzheimer's-related stress, says Jaffe.

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• Involve caregivers in your diabetes care. As Alzheimer’s progresses, caregiver participation becomes increasingly important, says Jaffe. Informed caregivers can support daily routines, review glucose data, and remind you to take medication.
• Check for driving safety. If your hypoglycemia risk or Alzheimer’s symptoms worsen, consider taking a driving safety assessment. Contact your state’s department of motor vehicles or your doctor to find someone who can test your driving skills.

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Your medical team can help you and your caregivers develop a plan for both diabetes and Alzheimer’s and offer additional support when needed. “The best outcomes come from treating this as a team sport: patient, caregiver, primary care, endocrinology, and neurology or geriatrics aligning around a realistic, low-burden plan,” says Majety.

• How can we adjust my medications for the best quality of life while staying safe?
• How can I monitor my response to medications?
• What symptoms mean I should call you or seek emergency care right away?
• What symptoms mean that Alzheimer's is progressing?
• Can you recommend any support resources?
• Can you refer me to a dietitian who specializes in geriatric and cognitive care?

Caregivers can also ask for tips on how to handle it if their loved one refuses to take medication, check their blood sugar, or eat. Your medical team can support you and your loved ones as you manage type 2 diabetes with early-stage Alzheimer's — you don’t have to do it alone.

• Diabetes and Alzheimer’s share some symptoms. It’s especially vital to recognize the signs of very low blood sugar, like confusion, sweating, and shakiness.
• You may be able to simplify your diabetes treatment plan. Ask your healthcare provider about medication changes, management options, and nutrition strategies that can help.
• Stay safe at home by checking your blood glucose when you have symptoms, staying hydrated, building predictable routines, involving caregivers, and keeping a hypoglycemia emergency kit handy.