How do you manage diabetes in older adults? Start with goals that fit the person's overall health, not one number for everyone. The American Diabetes Association's 2026 guidance asks care teams to look at medical, thinking, physical, and social needs, prevent low blood sugar, screen for problems such as falls and memory changes, and keep treatment as simple as it can safely be.
Key takeaways
- The American Diabetes Association (ADA) reports that more than 29% of people over 65 have diabetes. Health varies widely at this age, so plans should be personal.
- ADA 2026 recommends a full assessment of medical, psychological, functional, and social needs, plus yearly screening for problems such as memory changes, depression, falls, and frailty.
- Blood sugar goals depend on overall health. ADA suggests lower goals for healthy older adults and less strict goals for people with complex health, with avoiding lows as a priority.
- Older adults face a higher risk of low blood sugar, especially with insulin, sulfonylureas, and meglitinides. A care team may choose lower-risk medicines or simplify a plan; never change medicines on your own.
- Regular activity, enough protein, and fall prevention help protect strength and independence.
Why Is Diabetes Different in Older Adults?
The ADA's Standards of Care in Diabetes—2026, Section 13 calls diabetes in older adults "a highly heterogeneous condition." Some people developed diabetes years earlier and have significant complications. Others are newly diagnosed, sometimes after years of undiagnosed diabetes, and some have truly recent-onset diabetes with few or no complications. Type 2 diabetes is most common, but more people with type 1 diabetes are now living into their later decades.
ADA reports that older adults with diabetes have higher rates of functional disability, faster muscle loss, mobility problems, and frailty than older adults without diabetes. They are also more likely to have other illnesses, such as high blood pressure, chronic kidney disease, heart disease, and stroke. And they have higher rates of what doctors call geriatric syndromes: cognitive impairment, depression, urinary incontinence, falls, persistent pain, frailty, and taking many medicines at once (polypharmacy).
These problems can make daily diabetes care harder. ADA notes that older adults with diabetes often need more support from caregivers than those without diabetes.
Symptoms can also be missed. The National Institute on Aging (NIA) warns that older adults sometimes dismiss diabetes symptoms, such as feeling tired, being very thirsty, or healing slowly from cuts and bruises, as just part of "getting old." Those symptoms are worth raising with a clinician.
What Should a Diabetes Care Plan Cover After 65?
ADA recommendation 13.1 calls for a full look at four areas: medical, psychological, functional (how well a person can manage self-care), and social. Recommendation 13.2 adds yearly screening for geriatric syndromes, low blood sugar, and polypharmacy, because these can affect diabetes care and quality of life.
| Area | What the care team looks at (ADA 2026) | Questions you can bring |
|---|---|---|
| Medical | Type and duration of diabetes, complications, and other health conditions | Which checkups and screenings matter most for me now? |
| Thinking and mood | Memory screening for adults 65 and older, and depression | Is a memory screening due? Could low mood be affecting my care? |
| Daily function | Ability to handle self-care, plus falls, pain, and frailty | Which parts of my plan feel hard to keep up with? |
| Social and cost | Support at home, living situation, treatment burden, and cost barriers | Who can help me, and is there a lower-cost option? |
Recommendation 13.3 says screening for mild cognitive impairment or dementia should happen for adults 65 and older at the first visit, every year, and as needed. Our guide to whether diabetes causes dementia explains why the two are linked. If low mood lasts, see diabetes and depression.
ADA recommendation 13.8 says screening for diabetes complications should be individualized, with priority on problems that would affect daily function or quality of life. Ask which checks matter most for you. Our list of diabetes tests you may need each year and our appointment preparation checklist can help you plan visits.
NIA adds that a care plan can change after a change in health, such as a new diagnosis or complication, or after a change in care, such as going home from the hospital.
How Are Blood Sugar Goals Set for Older Adults?
There is no single target for everyone over 65. ADA's 2026 framework links goals to overall health:
- Healthy older adults with few other chronic illnesses and intact thinking and daily function: lower goals, such as an A1C below 7.0–7.5% (ADA recommendation 13.7a).
- Complex or intermediate health, such as several chronic illnesses, needing help with daily activities, or mild to moderate memory and thinking problems: less strict goals, such as an A1C below 8.0%, with avoiding lows as a priority (13.7b).
- Very complex or poor health, such as living in long-term care or having an end-stage illness: ADA says strict goals offer little benefit, and care should focus on avoiding lows and high blood sugar that causes symptoms (13.7c).
Less strict does not mean ignoring high readings. ADA warns that glucose above 180 mg/dL raises the risk of dehydration, weakness, infection, poor wound healing, and hyperglycemic crises. Our guide to what A1C should be for older adults covers the full framework, including fasting, bedtime, and continuous glucose monitor (CGM) goals.
Blood pressure goals follow the same idea. ADA recommendation 13.9 sets a goal below 130/80 mmHg for most older adults when it can be reached safely, and allows a goal below 140/90 mmHg for people in poor health or at high risk of side effects. See what blood pressure should be for a diabetic for more.
Why Does Low Blood Sugar Matter More With Age?
ADA recommendation 13.4 says older adults with diabetes have a greater risk of low blood sugar (hypoglycemia), especially when treated with insulin, sulfonylureas, or meglitinides. ADA lists irregular meals and worsening kidney function among the reasons. Memory and thinking problems can also make complex self-care, such as checking glucose and adjusting insulin, harder.
ADA Section 6 adds that older adults are particularly vulnerable to lows because they may be less able to recognize symptoms and communicate their needs. The link runs both ways: cognitive decline has been associated with a higher risk of lows, and severe lows have been linked to a higher risk of dementia.
For older adults with type 1 diabetes, or type 2 diabetes treated with insulin, ADA recommendation 13.5 recommends a CGM to improve glucose results, reduce lows, and reduce treatment burden. Our guide to low blood sugar in older adults explains warning signs, prevention, and what family members can do.
How Can Older Adults Stay Strong and Avoid Falls?
Falls are common and serious. The Centers for Disease Control and Prevention (CDC) reports that more than one in four older people fall each year, but less than half tell their doctor. Falling once doubles the chance of falling again.
The NIA's fall-prevention guide lists diabetes among the conditions that can affect balance and lead to a fall. Other risk factors include muscle loss, foot pain, unsafe footwear, blood pressure that drops when you stand up, and medicines that cause dizziness or confusion.
Regular activity helps. ADA recommendation 13.11b recommends aerobic activity, weight-bearing exercise, and resistance training as tolerated, especially to keep muscle. ADA's lifestyle section adds flexibility and balance training two to three times a week for most older adults with diabetes. Our guide to exercise for older adults with diabetes covers safe ways to start, including chair-based and balance exercises.
NIA's fall-prevention steps include:
- Have your eyes and hearing checked. See how often to get a diabetic eye exam.
- Learn the side effects of your medicines. Tell your doctor or pharmacist if a medicine makes you sleepy or dizzy.
- Stand up slowly, and ask to have your blood pressure checked while lying down and while standing.
- Wear nonskid, rubber-soled, low-heeled shoes. Do not walk on stairs or floors in socks.
- Tell your doctor about any fall since your last checkup, even if you were not hurt.
If you have numb feet or dizzy spells, see our guides to diabetic foot exams and whether diabetes can cause dizziness.
What Role Do Food and Weight Play?
ADA recommendation 13.11a calls for healthful eating with enough protein to help keep muscle and strength. ADA also asks care teams to pay special attention to malnutrition, which is linked to muscle loss, weaker grip, and lower quality of life. A registered dietitian can help set a protein amount that fits your health.
Weight goals depend on health. For older adults with type 2 diabetes and overweight or obesity who can exercise safely, ADA recommendation 13.12 says an intensive lifestyle program with food changes, activity, and weight loss of about 5–7% should be considered for its benefits on quality of life, mobility, and heart and metabolic risk. For frail older adults, ADA notes that the goal of a structured activity program is better function, not weight loss.
Diabetes education can help with meal planning and daily routines. See diabetes self-management education and support to learn what it covers.
How Can Medicines Be Kept Safe and Simple?
ADA notes that older adults are at high risk of polypharmacy and its side effects. Its 2026 recommendations ask clinicians to:
- Choose diabetes medicines with a low risk of lows, especially for people with risk factors for lows (13.13).
- Reduce medicines that can cause lows, such as insulin, sulfonylureas, or meglitinides, or switch to a lower-risk class for people at high risk of lows (13.14a).
- Reduce diabetes medicines when the harms or burdens may outweigh the benefits (13.14b).
- Simplify complex plans, especially insulin plans, to lower the risk of lows and the number of medicines (13.14c).
- Include medicines that lower heart and kidney risk for people with or at high risk of heart disease, heart failure, or chronic kidney disease, whatever their blood sugar (13.14d).
These are decisions for your care team. Never stop, skip, or change a medicine on your own, even if a plan feels complicated. Instead, tell your care team what feels hard: the number of pills, injection timing, glucose checks, or cost.
The NIA guide to taking medicines safely as you age offers tips that make that conversation easier:
- Make a list of every medicine you take, including over-the-counter drugs, vitamins, and supplements. Note the name, how much you take, when you take it, who prescribed it, and why.
- Show the list to all your health care providers, including physical therapists and dentists.
- Use one pharmacy when you can, so your pharmacist can check for problems between medicines.
If you are starting a new diabetes medicine, see what to expect when starting type 2 diabetes medication.
How Can Family and Caregivers Help?
ADA says support networks, such as adult children and care partners, should be included in diabetes discussions and shared decisions. Care partners can help by learning the person's low-blood-sugar plan, noticing changes in memory or daily function, and helping keep track of medicines and appointments.
Moves between care settings need extra attention. ADA notes that a move to a nursing home or other long-term care can lead to gaps in care goals, dosing errors, and changes in food and activity. ADA recommends diabetes training for staff in these settings and a careful look at each resident's mobility, thinking, medicines, and preferences.
For practical tips, see how to support someone with diabetes and how to help someone with low blood sugar. If your family is comparing communities, our guide to diabetes management programs for senior living lists questions to ask on a tour.
What Help Is Available With Diabetes Costs?
ADA recommendation 13.15 asks care teams to consider the cost of care and insurance coverage when choosing a treatment plan, since many older adults take several medicines and live on fixed incomes.
Medicare Part B covers outpatient diabetes self-management training for eligible people when a doctor or other provider orders it. After the Part B deductible, you pay 20% of the Medicare-approved amount. Medicare also limits what you pay for each covered insulin product to no more than $35 for a one-month supply, and you do not pay a deductible for insulin. Other costs may apply, so check your plan.
NIA suggests telling your care team if you have trouble paying for diabetes medicines or supplies, and asking whether a less expensive option or a generic version is available.
When Should You Get Help?
Emergency: Call 911 if someone with diabetes is unconscious, having a seizure, cannot swallow, or is getting worse despite following their low plan. Also call 911 for sudden face drooping, arm weakness, or speech trouble. CDC advises that an older person who falls and hits their head should see a doctor right away, especially if they take blood thinners.
Same day: Contact your care team the same day after any low that needed someone else's help, or if lows keep happening. Also call if you are sick and cannot keep food or fluids down; our diabetes sick day rules guide explains what to ask.
Prompt appointment: Book a visit for new memory or thinking changes, a recent fall, new trouble with daily tasks, fear of falling, or trouble paying for medicines.
Frequently Asked Questions
What is a good A1C for an older adult?
It depends on overall health. ADA 2026 suggests goals such as an A1C below 7.0–7.5% for healthy older adults and below 8.0% for those with complex health. For people in very poor health, ADA advises against relying on A1C and focusing on avoiding lows and high blood sugar that causes symptoms. Your clinician sets your goal.
Why are older adults more likely to have low blood sugar?
ADA 2026 points to irregular meals, worsening kidney function, memory and thinking problems, and medicines such as insulin, sulfonylureas, and meglitinides. Older adults may also be less able to recognize low blood sugar symptoms or tell others about them, which is why care partners should learn the warning signs.
Should older adults with diabetes be screened for memory problems?
Yes. ADA 2026 recommends screening for mild cognitive impairment or dementia for adults 65 and older at the first visit, every year, and as needed. Thinking problems can make self-care harder and are linked to a higher risk of low blood sugar, so results can help shape a safer, simpler plan.
What kind of exercise is best for older adults with diabetes?
ADA 2026 recommends aerobic activity, weight-bearing exercise, and resistance training as tolerated, plus flexibility and balance training two to three times a week for most older adults with diabetes. Walking, chair-based strength moves, and tai chi are options to discuss. Ask your care team which activities are safe for you.
Does Medicare cover diabetes education?
Yes, for eligible people. Medicare Part B covers outpatient diabetes self-management training when a doctor or other provider orders it. After the Part B deductible, you pay 20% of the Medicare-approved amount. Some people may also qualify for medical nutrition therapy.
Can diabetes treatment be reduced with age?
Sometimes. ADA 2026 recommends reducing diabetes medicines when the harms or burdens may outweigh the benefits, and simplifying complex plans to lower the risk of lows. These decisions belong to your care team. Do not stop or change a medicine on your own.
References
- American Diabetes Association Professional Practice Committee for Diabetes. “13. Older Adults: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S277–S296. Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. “6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S132–S149. Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. “5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1):S89–S131. Accessed October 2026.
- National Institute on Aging. “Diabetes in Older People.” Accessed October 2026.
- Centers for Disease Control and Prevention. “Facts About Older Adult Falls.” Accessed October 2026.
- National Institute on Aging. “Falls and Fractures in Older Adults: Causes and Prevention.” Accessed October 2026.
- National Institute on Aging. “Taking Medicines Safely as You Age.” Accessed October 2026.
- Medicare.gov. “Diabetes Self-Management Training.” Accessed October 2026.
- Medicare.gov. “Insulin.” Accessed October 2026.
- Cicero. On Old Age (De Senectute), translated by Andrew P. Peabody. Online Library of Liberty. Historical context only for the companion feature. Accessed October 2026.
Next Steps
Bring three questions to your next visit: which goals fit your health now, whether a memory or fall screening is due, and whether any part of your treatment plan could be simpler. Bring a family member if that helps.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program offers a holistic approach to diabetes type 2 that organizes learning about meals, movement, sleep, and stress. It does not diagnose or treat diabetes, set blood sugar goals, interpret test results, change medicines, or replace your care team.