Diabetes in the Older Adult

Glucose regulation becomes less resilient with age. Beta-cell insulin secretion declines, insulin resistance often increases, and the hormonal response that normally raises glucose during a low becomes weaker. The result is a narrower safety margin: hyperglycaemia may cause dehydration and functional decline, while hypoglycaemia may occur with little warning. A younger person with hypoglycaemia may report tremor, palpitations, sweating, and hunger. An older adult may instead become quiet, confused, unsteady, irritable, or unusually sleepy. These neuroglycopenic features are easily mistaken for delirium, dementia progression, stroke, or “just another fall.” A sudden change from the person’s baseline should prompt a bedside glucose check before it is attributed to chronic cognitive decline. Frailty magnifies the consequences of both extremes. Reduced muscle mass and inconsistent food intake reduce glucose reserves. Kidney impairment can prolong the action of insulin and renally cleared medications. Visual impairment, arthritis, memory loss, and complex medication schedules can turn an otherwise reasonable treatment plan into an unsafe one. Age does not establish diabetes type. New rapid-onset hyperglycaemia with unintentional weight loss, ketosis, or marked symptoms requires urgent assessment rather...