My husband has dementia and is pre-diabetic. How do I keep him healthy?

Get rid of breads , potatoes . Rice , crackers. These run up your sugar. Use a natural sweetener . My mother was fixated on werthers candies . Do consider sugar free candies as treats . If you can check his sugar with meals . You will know what ins it up. Exercise is the best thing to do after eating . Best of luck .

If you're asking for opinions, I say "let him have his way and just enjoy him for as long as you have him." You can pretty accurately guess how "diabetes pans out."

To me, there's no reason to be overly cautious about health, particularly concerns about long-term health. Once diagnosed, why would you want to prolong your life to the point where you've completely lost your cognitive ability?

However, there's quality of life to consider. If he eats so much that he becomes obese, he and you would suffer. Or, if he does wind up insulin dependent, the injections and other maintenance would be confusing and anxiety-inducing for him and potentially overwhelming for you. The list goes on.

So, I'd go ahead and stock up the pantry with artificially-sweetened goodies. He doesn't have to fear the negative effects of the sweeteners in the same way that you do and he deserves the pleasure of eating them. Deprivation (and if he is addicted to sugar, that's what he'd feel) isn't something you'd want lumped on top of the confusion he's already feeling.

I'd be thankful that it's just sugar that he craves. Imagine if it were alcohol.

Try to have him seen by a endocrinologist. Dealing with pre diabetic & it's management has really changed the past few years from the "deprivation" approach of the past.

Is he on metformin?
? If not, I'd bet he will be placed on it. It is a pretty great drug for keeping the pre diabetic from going into the diabetes zone. You kinda have to start it once a day for a month, then twice a day after that. It takes a tummy adjustment that first month. One nice side effect is that it keeps you regular.

I think a lot of binge feeding is about satisfying "mouth feel" - this is what snack foods & high sugar foods do so well. If you can find items better nutritionally that do the same mouth feel that may be a way to manage this. I'd first try to determine if he is a super sweet (high sugar stuff) or a savory sweet (salty & sweet) and then if he is a creamy (foods that dissolved& more dense) or crunchy (bigger bites usually with more air) as to which satisfies the addiction. Then find better substitutes for them.

Whatever the case, ditch those soft drinks as the first step. Switch to diet ginger ale or flavored carbonated waters if this is about the fizz - these are no calories. Fruit juices are a minefield as lots of those on the shelves are high sugar blends, so you kinda have to read the packaging.

There are many medications in use before moving on to injectable insulin...I've also recently read that very tight blood sugar control can result in hypoglycemia which can be dangerous as well. Don't go overboard...especially if he is over 80 years old.

Yes, sugar is very addicting, as I’ve seen in my own family. I feel for you.

It would help tremendously, of course, to limit his carbohydrate (sugars and starches) intake. For sure, keep him away from high-fructose corn syrup (HFCS). Artificial sweeteners are unhealthy, too. There are some good natural sweeteners that are very low in sugar. I’ve had success with stevia. This website mentions some others: ketodietapp/Blog/post/2013/06/10/Top-10-Natural-Low-carb-Sweeteners

Try to increase his fiber. Fiber will slow down blood sugar absorption, thereby reducing spikes in blood sugar. If he won’t eat high-fiber foods (such as lettuces, celery, cucumbers, etc.), get him to take psyllium husk supplements. You can get it in powder form, which is a lot cheaper. But it needs to be added to foods or drinks, and that might be too much work for him. Psyllium husk capsules are more expensive but also more convenient to take.

Get good fats in him. Good fats are natural fats, as opposed to man-made ones that come out of a laboratory. So no margarine. Stick with pure natural butter, extra virgin olive oil, organic coconut oil, raw walnuts, raw almonds, raw macadamia nuts, raw pecans. Also beneficial is MCT (medium-chain triglycerides) oil. Eggs from pastured hens are great, too. Even fat from the meat of grass-fed animals is good. If his doctor has him on (or is trying to get him on) a low-fat diet, then his doctor is not on top of the latest research in cardiovascular and brain health.

When he eats ice cream, get the best quality, which is higher in natural fat and has no high fructose corn syrup.

I recommend you explore the ketogenic diet, which is high-fat, moderately low protein and very low carb. A lot is available on YouTube. It might be too extreme for your husband, but even some improvement in the higher-fat and lower-carb direction would most likely help.

When the body is deprived from fats, it naturally craves a replacement. Sugars and starches are generally that replacement.

Lastly, try cooking with coconut flour. It’s higher in fiber and lower in carbs than wheat flour. There are some good coconut flour recipes on the web. I’ve made crepes and shortbread using coconut flour, with stevia as my sweetener. Coconut flour requires more eggs than wheat flour. But remember: eggs are good for you!

All the best,
Lilacalani

My husband had diabetes when he was diagnosed with dementia. I have diabetes and I am insulin-dependent. I'm going to echo much of what has already been said:

First, recognize that dementia is a terminal condition. Certainly you want to avoid the long-term possible consequences of diabetes, but you do need to weigh the misery of an enforced diet now against the possible consequences of diabetes later. Is he going to live long enough to worry about insulin? About eye problems? About the other risks? However long he lives my goal would be to increase his pleasure, not to increase his "health." Of the multiple choices you listed I'd lean toward "Do I let him have his way and just enjoy him for as long as I have him?"

I do agree, though, that having him seen by a specialist (endocrinologist) would be a smart thing to do. Even better, get an appointment with a Certified Diabetes Educator, who will help you sort fact from fiction regarding a positive diabetes lifestyle. (Insurance covers these visits.) For example, you will learn that exercise is as important as food in blood sugar control. (And exercise is also very good for persons with dementia.) You will hear that carbohydrates, rather than just sugar, impact blood sugar. Most baked goods and candies that are sugar-free have to have some other carbohydrate to make up the volume. Read labels -- the "sugar-free" items are no easier on blood sugars that the real things.

I don't think you should go overboard being concerned about blood sugar levels, but to the extent that you want to be somewhat careful, at least know what really matters and don't get suckered by marketing slogans. A CDE visit is very worthwhile.

Desserts when you eat out? Go for it! (I'm assuming you do not eat out 8 times a week.) A piece of candy from a co-worker's dish? I doubt that is going to lead to foot amputation.

My son was diagnosed with diabetes at age 35. My advice for him is VERY different from what I am saying about your 80-year-old husband who has dementia. And it is different from what I practice myself. (I'm 70, no dementia.) I looked out for my husband's mental health and tried to give him as many pleasurable experiences as I could in the ten years we took his dementia journey together.

(And, BTW, both the wonderful geriatrician and the world-class dementia expert who served my husband said "let him eat what he wants.")

You don't say how old he is, but generally it takes a while (i.e. several years) to progress from prediabetes to diabetes to insulin. Agree that there are a lot of advantages to letting an older person with dementia eat what he likes.

I would mainly encourage you to get him to exercise. Take walks together, or do whatever keeps him moving. As others noted above, this will be good for his pre-diabetes but also for his dementia, his mood, his behavior...and also your health.

In general, for people in late-life with dementia and prediabetes or mild diabetes, a little high blood sugar doesn't cause a lot of harm. However if he gains a lot of weight then he certainly could develop more arthritis pain or mobility problems, so it might make more sense to follow his weight than his blood sugar.

Good point about weight, drkernisan. Dementia plays havoc with weight regulation, too. My husband lost a lot of weight; a friend with the same kind of dementia gained a lot of weight. In both cases it was out of proportion to what they ate. That may have to be factored in when considering meal planning, too.

But EXERCISE is critical. Even folks who can't walk can get in some daily exercise. I think focusing on that in fun ways has a better pay back than restrictive diets.

I'm not sure how often he use to drink, but quitting alcohol is very hard to do (even if you only drank one glass a day/every few days). Sometimes we replace our addiction with another addiction. (In this case, sugar). Since alcohol turns into sugar, its a good possibility that he is missing his usual sugar fix and is subconsciously attempting to replace it. Be patient, as weaning may be best for this situation as opposed to stopping cold turkey.