Living Beyond the Numbers
What Seniors Really Need to Know This Diabetes Education Week
You’ve had diabetes for years. Maybe decades. The diagnosis isn’t new, and honestly, you’re tired of the same old advice. This National Diabetes Education Week, let’s talk about what actually matters when you’re over 65 and diabetes has been your companion longer than you care to remember.
Nearly one-third of adults over 65 have diabetes, but here’s what your doctor might not emphasize: the disease behaves differently in older bodies. Your risks have shifted. Your needs have changed. And those strict guidelines you’ve been following? Some might be doing more harm than good.
The Types Nobody Talks About
You know Type 1 and Type 2. But up to 12% of people diagnosed with Type 2 after 35 actually have LADA (Latent Autoimmune Diabetes in Adults), sometimes called Type 1.5. It progresses slowly, which is why it gets missed. If you weren’t overweight at diagnosis and needed insulin faster than expected, this could be you.
Then there’s Type 3c diabetes from pancreatic damage. About 79% of cases come from chronic pancreatitis. This type causes severe blood sugar swings despite your best efforts. If you’ve had pancreatic issues and your numbers seem impossibly erratic, investigate this.
When “Good Control” Becomes Dangerous
That A1C target of 6.5% or 7% drilled into your head? It might be too aggressive now.
Studies show older adults with tight glucose control face significantly higher hypoglycemia risks. In people 80 and older with long-standing diabetes, hypoglycemia rates reach nearly 16 events per 1,000 person-years.
The 2024 ADA guidelines changed the game. Healthy older adults should aim for A1C between 7.0-7.5%, those with multiple conditions should target below 8.0%, and those with complex health issues should focus on avoiding dangerous highs and lows rather than hitting specific numbers.
Your Medicine Cabinet Needs Attention
Polypharmacy affects up to 64% of older adults with diabetes. More medications don’t equal better control. They equal more falls, confusion, and severe hypoglycemia.
If you’re taking five or more medications, your risks multiply. Deprescribing, the careful reduction of unnecessary medications, has shown remarkable success without compromising blood sugar control.
What Your Feet Are Saying
Up to 50% of people with long-standing diabetes develop peripheral neuropathy, losing the ability to feel pain. You could step on a thumbtack and not know it.
About 15% will develop a foot ulcer at some point, and risk increases with age and diabetes duration. Daily inspection isn’t vanity. It’s preservation. Use a mirror if needed. Check between toes. Look for any changes. Get help if you can’t do it yourself. You might also check to see if Medicare will pay for visits to a podiatrist to cut your toenails.
The Morning Mystery
The dawn phenomenon affects more than 50% of people with diabetes. Between 3 a.m. and 8 a.m., your body releases hormones that tell your liver to pump out glucose. Without proper insulin response, you wake up with inexplicably high numbers.
Solutions include eating dinner earlier, avoiding bedtime carbs, evening walks, or adjusting medication timing. But first, you need continuous monitoring to see what’s actually happening.
The Sleep Problem Nobody Mentions
Seventy percent of people with Type 2 diabetes have obstructive sleep apnea. Sleep apnea triggers stress hormones that raise blood sugar, creating a vicious cycle.
Treatment with CPAP can lower average 24-hour glucose and reduce the dawn phenomenon by 45%. That’s as powerful as adding another medication, except it addresses the root cause. If you’re doing everything “right” but struggling with control, especially morning highs, ask about a sleep study.
Technology That Makes Sense
The 2025 ADA Standards now recommend considering CGM for adults with Type 2 diabetes on any glucose-lowering medication.
CGM shows patterns you’d never catch with finger sticks and alerts you to dangerous lows before you feel symptoms. Studies show older adults using CGM spent 27 minutes less time in hypoglycemia daily. Another study found they increased time in range by 19% compared to 12% in younger adults.
The Protein Problem
Older adults with diabetes need 25-30 grams of protein at each main meal to maintain muscle. Yet not a single elderly person with diabetes in one study hit the protein target at breakfast. The average? 6.9 grams.
Without adequate protein, you lose muscle faster, leading to frailty, disability, and worse blood sugar control. Think eggs, Greek yogurt, cottage cheese, or protein powder at breakfast instead of toast and juice.
Moving Beyond Walking
Walking is good. But resistance training builds and maintains muscle mass in ways walking can’t. You lose muscle faster than non-diabetic peers, and diabetes makes you twice as likely to develop sarcopenia.
Resistance training alone can reduce A1C by 0.57%, and when combined with aerobic exercise, the reduction jumps to 0.97%. It also improves bone density, reduces fall risk, and maintains independence.
Balance exercises deserve equal attention. Falls aren’t normal, and with diabetes, your risk is higher due to neuropathy. Simple exercises like standing on one foot or tai chi dramatically reduce fall risk.
The Vision Crisis
With diabetes, you’re 1.5 times more likely to develop cataracts and glaucoma. The combined prevalence reaches 29% among older adults with diabetes versus 22% without.
Diabetic retinopathy often has no early symptoms. By the time you notice changes, significant damage may have occurred. The solution requires commitment: comprehensive eye exams at least annually, not just when you notice problems.
When Kidneys Complicate Things
About 29% of people over 65 have reduced kidney function with eGFR below 60. But current definitions may overdiagnose kidney disease in elderly people experiencing normal age-related decline.
This matters because a kidney disease diagnosis affects medication choices. Current guidelines support metformin use down to an eGFR of 30 if properly dosed. Work with your doctor to understand what your numbers mean in context, not just treating numbers on a lab report.
The Emotional Weight
Between 14% and 28% of older adults with diabetes experience depression, two to four times higher than the general elderly population. Diabetes distress, the frustration and overwhelm specific to living with diabetes, affects 18-35%.
You may be dealing with loss of independence, loss of a spouse, reduced social connections, and physical limitations while managing a demanding chronic condition. Mental health screening should be routine, not occasional.
The Flexibility You Deserve
Major organizations now explicitly recommend deprescribing when risks outweigh benefits. Your A1C target should reflect your health status, not universal guidelines.
Time in range is emerging as more important than A1C, especially for older adults where A1C can be inaccurate. Instead of obsessing over a single number every three months, continuous monitoring shows how much time you spend in target range and patterns you can act on.
What This Week Really Means
National Diabetes Education Week isn’t about scaring you with complications you already know or lecturing about lifestyle changes you’ve heard a million times.
It’s about recognizing that diabetes management after 65 requires different strategies. Your body has changed. Your priorities have evolved. Your care should reflect that reality.
You deserve personalized treatment that considers your functional status, other health conditions, cognitive function, and most importantly, your goals for your remaining years. Quality of life isn’t just nice to have. It’s the whole point.
After all these years of living with diabetes, you’ve earned the right to focus on living well, not just controlling numbers.
