When you think of diabetes, you probably think of symptoms like high blood sugar and frequent urination. But many people with diabetes also experience cognitive impairment, which affects their learning and thinking skills. If you’re a caregiver for someone with diabetes, it’s important to understand the cognitive challenges they might face. It’ll give you a better idea of how well your loved one functions and what they can do on their own. Up to 50% of people with diabetes may experience some form of cognitive impairment. The specific areas affected by diabetes include memory, attention, and executive function, which is the ability to plan, focus attention, and remember instructions. Cognitive problems from diabetes seem to happen separately from physical symptoms like high blood sugar. In other words, even when physical symptoms are well controlled with medication, your loved one may still have problems with thinking and learning. It’s not that cognitive problems are just another symptom of diabetes. Instead, research suggests it’s more likely that factors that raise your risk for diabetes seem to boost a person’s odds of having these other problems, too. For example, high blood sugar levels over time can damage blood vessels in the brain, leading to cognitive impairment. But genes alone don’t cause diabetes or cognitive impairment. It’s likely that circumstances in a person’s life and the world around them contribute. For example, poor diet and lack of exercise raise the odds that a person will have diabetes later in life. These same problems are a risk factor for cognitive problems both in people with and without diabetes. Thinking and learning difficulties in people with diabetes can be a major barrier to managing their condition. People with cognitive impairment struggle to fully function even when their physical symptoms are well controlled with medicine. One major challenge for people with diabetes-related cognitive problems is following their doctor’s recommended treatment plan. The people who have these thinking and learning struggles are less likely to take their medicine and follow other treatment instructions as they should. Medicine for diabetes helps with physical symptoms, but it has little or no effect on thinking skills. That’s why cognitive problems seem to go on even when physical symptoms clear up. But a program called cognitive remediation may help. In this therapy, a trained specialist takes you through exercises and drills aimed at strengthening the thinking skills that can be weak in people with diabetes. You also come up with strategies to help you function better in day-to-day life. People seem to get the most benefit from cognitive remediation when they do it in combination with standard psychotherapy and medication. Research shows that it can affect targeted thinking skills and quality of life in general. People who go through the program may also have less need for social and assistive services. The best way to preserve the improvements in quality of life, studies suggest, is to continue with standard psychotherapy for the long term after you complete the cognitive program. If you stop all therapy after the program, symptoms and challenges living daily life may come back after a year or so. People who stay with standard therapy may hold on to the benefits of cognitive remediation for 10 or more years. Whether you live with a loved one with diabetes or offer help from time to time as needed, there are things you can do to give them the best care. Educate yourself. Now that you know about the cognitive problems that can come with diabetes, you have a better idea of what parts of daily life and self-care might be hard for your loved one. Keep learning about the condition so you know what to expect and what might be needed from you. Offer help where needed. You might notice tasks of daily living that are a struggle for your loved one. Now you understand why. Discuss ways that you can help or that you can get help for them, whether that means pitching in around the house a few days a week or helping find a better living situation with more support. Partner in health care. Encourage your loved one to get care and stick with it. Offer to help them remember to take medication or get to therapy sessions. You might offer to attend doctor’s appointments with them, where you can help take notes and ask questions. Don’t bulldoze. Your loved one is more likely to feel invested in their care and recovery when they have a say in the decisions. Encourage them to get care and offer help at home, but don’t take over. Instead, offer the kind of assistance that would help keep them as independent as possible.