How do I help my father with vascular dementia and Type 2 Diabetes control food intake?

Sarah, you could first try to prepare all meals in advance (lot of work, I know), and see if he'll eat them.

If not, your intentions are admirable, but your father is not cooperating. You can't change his behavior; he has to want to do that by himself.

But you might try some tough love. Print out some articles on the short and long term side effects of uncontrolled and/or advanced diabetes, including having to wear an insulin or facing amputation of a deceased limb. That might scare him into compliance.

It seems cruel, but he has to realize the chances he's taking, and only he can change his attitude.



Good luck.

All you can do is your best. It sounds like you are already doing that.

I think you need to look at the entire picture here. Your dad has vascular dementia. Studies show the average life expectancy after diagnosis with this condition is about 4 years. Now that is an average, meaning some people die sooner than that, and others live much longer. But it is fairly unlikely that your father will live to be 80 no matter how good his diet is and how well managed his blood glucose is.

That blunt truth helped me to establish my caregiving goal for my husband, who had Lewy Body Dementia. My goal became to help him have the best quality of life he could under the circumstances.

That your poor dad thinks he has to hide his fast-food purchases from you is sad. I don't think that contributes to his quality of life in these last few years, do you? I know that your intentions are absolutely sterling. I'm just not sure how realistic they are.

Let an endocrinologist keep making adjustments to try to manage the blood sugars a little better, without being depressingly restrictive in the diet. And do consider an insulin pump!

My husband had followed a "heart healthy" diet all of his adult life. Once he was diagnosed with dementia both his neurologist and his wonderful geriatrician said let him eat whatever he wants now. That relieved stress from both of us.

You can't change him honey - you will drive yourself insane if you continue trying.

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

You'll only make yourself sick trying to change his habits. Let him know you're there if he want assistance but he's a big boy and he will do what he wants and eat what he wants.

The only option you have is to make sure his doctor(s) advise him what lies ahead if he doesn't change his habits. But "sugar consumption" is an addiction for a lot of people.

Please talk to an endocrinologist and not a GP. I recommend a diabetes care center. An insulin pump is a great option. His basal insulin doses will run in the background. Only when he does eat, an additional insulin bolus will be made with the pump, based on how many grams of carbohydrates he consumed. There is no food avoidance or "diabetic diet" anymore. A Continuous Glucose Monitor works with the pump. Please Google Medtronic 670G. Wearing a pump is not a punishment for "bad" patients or only for people dying. It is an external pancreas so to speak. 

SarahK, there are some good points made above. (What is your dad's A1C?) Is it okay or really high? If it's not really high, I would try to work with what he's doing. If it's really out of control, then, I might encourage him to do things differently, keeping in mind that you may not be able to get him to eat what you think he should be eating.

As a Type I diabetic, I believe that I do have a unique perspective on managing diabetes. I'm no expert, but, I do manage mine pretty well. It has taken me years though and it is a full time job. It requires a lot of planning, checking, counting, and discipline. If your dad is not on board, I wouldn't get overly stressed about it. You can't force it. I would focus on what you can help with.

First, I would get him to a good Endocrinologist. Preferably, one that focuses on diabetes. If you can find a division of a teaching hospital, that's good. I go to UNC Endocrine. Top notch. The Endocrinologist can evaluate your dad, provide options that he can handle and look to the future. Once, his dementia progresses, it'll be easier, because his food and meds will be administered to him by others.

Second, I would ask the doctor about finding a way to cover the carbs your dad eats, since, you can't prevent him from eating them. There are pills that can be taken along with some insulins. The key is finding the right combination. Having too low blood sugar can be as dangerous as too high.

Does your dad have any interest in checking his blood sugar throughout the day? Most people don't. If he will do it, it would help figure out what his needs are.

I wear a Continuance Glucose Monitor, (you wear a sensor that sticks under the skin on your belly. You also have a receiver that shows your blood sugar level. A device (you wear on your belt or may use your phone) for a senior with early stage dementia? I'm not sure how that would work. It requires a lot of work, education, and supervision. I can't see a senior with early dementia managing it. Not very practical. You can discuss it with his doctor and a Certified Diabetes Educator. A pump also requires a lot of work, management and care. And it runs the risk of too much insulin. I can't imagine they would prescribe that for a person with dementia.

I hope you can get the answers you need to help your dad. Once, my LO's vascular dementia progressed, she did fine with her pills being given to her in the morning and then a regular healthy diet the rest of the day. She isn't restricted that much, but, gets treats occasionally. Her meals and snacks are provided to her by the MC staff. Her A1C has maintained at a very good number for several years. This keeps her more comfortable. That is my goal now.  

I agree with those who said let him eat what he wants. My late husband had vascular dementia (although not diabetes), diagnosed about 5 years before he had the stroke that killed him....and he ate a fairly healthy diet and had lost weight. Your father probably isn't going to live much longer than that no matter what he eats, so why not let him enjoy life as much as he can?

Living longer is not necessarily a great goal for people who have dementia. Living better with whatever time they have left was my goal for my demented husband and mother.

Sarah,
I think you have some good suggestions here. You are wonderful to care so much for your father and his health. But I whole completely agree with those who say not to stress about this.
I guess my view is this, if you had his health problems and were constantly made to feel as if you were doing something wrong by what you , as an adult chose to eat, how would you feel? Even with early-ish stage of dementia, he may be forgetting the rules, and the reasons behind them, or he may not care. That is his right. I say make him the meals that you want to , and do not worry about what he eats on his own. If it isn't causing him pain and assuming he isn't reading at 400+ on a regular basis, I'd say let it be.
When people start losing control over their lives as happens too often as we age, all too often the only thing we have left to control is what and when we chose to eat. Let him have it his way for as long as he is able.
I wish you well.
Best,
Margaret

Who controls his cash, debit card and credit cards, e.g. the way he pays for these food deliveries and take out meals? You could take that option away. One way to control it.

I have the same problem with my dad! It's very sad. I think what some people who responded aren't addressing is that he has dementia. I think if they had round the clock caregivers they could monitor what he eats much better. I think this will promote a longer life for him. Everyone else, don't be so judgemental because she loves him and wants him to live longer!