Deprivation of liberty to safeguard against recurrent ketoacidosis

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Advances in medical treatment have resulted in prolonged survival of people with diabetes, with multiple complications. Vascular dementia is one of these and is increasingly seen due to a reduction in mortality from cardiovascular causes. People suffering from dementia are often not capable of weighing up the advantages and disadvantages of proposed treatment in order to give an informed decision. In most cases, this incapacity does not cause problems as patients and their carers agree with the recommendation made by their health care professionals. However, we encountered a challenging case where we had to apply for deprivation of liberty safeguards (DoLS) to treat in the patient's best interests.We report the case of a patient with vascular dementia who had repeated admissions with life-threatening diabetic ketoacidosis (DKA) as she refused to comply with the insulin treatment because of her lack of insight regarding her diabetes care. In order to prevent harm to her, an application was successfully made for DoLS. This allowed treatment with once-daily, long-acting analogue insulin under supervision even against her wishes. This prevented further admission to hospital with DKA.DoLS was introduced in the UK in April 2009 to safeguard some of the most vulnerable people in our society for their own safety. People with type 1 diabetes are increasingly surviving longer and may suffer from dementia. The majority will manage with some help from family or health care worker, but in a small proportion DoLS may be needed, as in our case, to prevent recurrent life-threatening complications. Copyright © 2013 John Wiley & Sons.

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