For older adults, the safest plan is often the simplest. The goals: fewer lows, fewer burdens, and more good days.
What to know
- Individualize targets:
- Tighter goals if healthy/independent; looser targets if multiple conditions, cognitive/functional limits, or high hypoglycemia risk.
- Avoid hypoglycemia—it’s linked to falls, heart events, and hospitalizations.
- Simplify regimens:
- Prefer low‑hypo‑risk meds (metformin if tolerated, DPP‑4i, SGLT2i, GLP‑1 RA); review need for sulfonylureas and complex insulin plans.
- Once‑daily dosing and fixed‑dose combinations can reduce complexity.
- Comprehensive care:
- Screen for complications, falls risk, neuropathy, vision/hearing issues, depression, cognitive change, malnutrition.
- Review polypharmacy and kidney function regularly.
Take action
- Medication review every visit:
- Ask, “Can we simplify?” Consider deprescribing agents with high hypo risk or limited benefit.
- Nutrition that fits appetite and dentition:
- Protein at each meal (eggs, dairy, fish, beans); easy‑to‑chew options; hydrate; address food insecurity.
- Activity for function:
- Aim for walking plus 2–3 days of light strength and balance (sit‑to‑stands, heel raises, light bands, tai chi).
- Safety setup:
- Check vision/footwear; remove trip hazards; keep hypo treatment visible; set CGM/meter alerts conservatively if used.
Talk to your clinician about
- Personalized A1c/BG targets and reducing hypoglycemia risk.
- Kidney‑appropriate doses; when to pause SGLT2i during illness/surgery.
- Whether insulin can be simplified to basal‑only or fewer injections.
- Vaccinations (influenza, pneumococcal, shingles, COVID‑19, Tdap).
Quick glossary
- Deprescribing: safely reducing or stopping medications that no longer help or may harm.
- Polypharmacy: taking many medications—raises interaction and side‑effect risks.
- Time‑in‑Range (TIR): CGM percent of readings in target range; can complement A1c.
Safety note
Any confusion, falls, chest pain, severe low blood sugar, or sudden weakness/vision/speech problems needs urgent evaluation.
References
- ADA Standards of Care—Older Adults
- NIA: Healthy Aging
- Reviews on hypoglycemia risk and simplification in older adults with diabetes