TABLE 1.

Daily Diabetes Self-Management Tasks Affected by Cognitive Impairment

TaskImpairment
Glycemic monitoring• Cannot remember how to perform a fingerstick blood glucose test
• Cannot remember at what time a blood glucose test is required
• Unable to recognize or communicate hypoglycemia or signs of hyperglycemia
• Unable to access the glucose testing device memory to recall the last blood glucose value
• Forgets to wash hands before a blood glucose test, leading to an inaccurate result
• Cannot remember the blood glucose test value to accurately transcribe it on a log sheet or use it to direct insulin dosing
• Unable to determine the appropriate actions to take based on a determined blood glucose level (e.g., for hypoglycemia or sick-day management)
• Unable to use a continuous glucose monitoring device
• Unable to determine when or how to check urine or blood for ketones
Nutrition• Forgets to eat, frequently misses meals, or eats smaller meals than anticipated, resulting in a higher risk of hypoglycemia
• Eats too frequently or too much, resulting in hyperglycemia
• Has unpredictable eating, resulting in wide glycemic excursions
• Unable to perform meal planning or meal preparation tasks
• Cannot determine carbohydrate content of food (if applicable)
Mobility and physical activity• Cannot remember to engage in prescribed physical activity such as taking a walk or performing wheelchair exercises
• Cannot remember how to return home after taking a walk
• Cannot remember how to prevent or treat hypoglycemia when active
• Forgets to carry carbohydrate during physical activity (to treat hypoglycemia, should it develop)
• Unable to incorporate physical activity into a daily regimen
• Has slower gait or speed, shortened strides, and poor balance; prone to falling
• Does not use assistive devices (e.g., a cane or walker) when needed
• Lacks initiative to engage in prescribed physical activity
Medication management• Cannot remember when to take medications
• At risk of inaccurate dosing, resulting in overdose or double-dosing
• Unable to determine the correct dose of insulin to take at a designated time
• Unable to track when refills are needed and obtain refills or new medications
• Cannot remember how to properly store insulin or other diabetes supplies
• Unable to use insulin administration devices, including insulin pens, insulin syringes, or an insulin pump
Personal hygiene• Cannot remember to bathe, resulting in an increased risk for skin breakdown and infections
• Has poor foot care, resulting in increased risk of ulcers, infections, and amputation
• Has ineffective oral hygiene
Coordination of health care services and appointments• Unable to schedule and track medical appointments
• Unable to navigate through a complex health care system
• Has difficulty using an automated telephone service
• Unable to travel independently to appointments