Older adults living with type 1 diabetes

What this guide does, and what it does not

Older adult type 1 diabetes is the long arc the adult guide began. Some readers arrive at this guide already holding decades of pattern-reading and a settled routine. Some arrive supporting a parent or partner whose diabetes work has started to widen across the household. The split that follows is reader-led: an active part for the reader holding most of the work themselves, and a needing-more-support part for the reader where the household, the district nurse, or the care team has started to carry more of it.

What this guide does is name the foundations that the years have already taught and the named shifts the older-adult band is known for. What this guide does not do is hand you a number to take this evening. Every figure on these pages is a population-average reference at your total daily dose, not a personal dose; the dose conversation is with your care team. The cross-hub bridge into this guide is the adults guide, and the cross-hub bridge out is the female guide for the female reader at any life stage.

How the years split the work in this band

The split in this guide is not the calendar split between sixty-five and seventy-five. The body does not change shape on a birthday; the diabetes work does not either. The split is the work-shape split between the reader still holding most of the diabetes work themselves and the reader where the household around the diabetes is starting to do more. Both are normal. Both are part of the long arc. The reader, or the family member supporting the reader, picks the part that fits the work they are currently doing.

The order of the two parts is set by where you are, not by the number on the kicker.

The foundations are largely intact, and the shifts are named

The honest summary of the older-adult-band literature is that the diabetes math the reader has already built is largely the math the reader keeps. Total daily dose, insulin-to-carb ratio, insulin sensitivity factor, IOB visibility, hypo recognition, and hypo treatment all carry forward from the adult guide. The conversation in clinic does not start over in this band; it widens to take in the named shifts the older-adult literature surfaces (ADA 2026 §13).

The first named shift is hypoglycaemia awareness. The risk of impaired awareness of hypoglycaemia rises with duration of T1D and with age; rehearsing the signs with someone in the household, and asking the team for an IAH score at the annual review, are the levers the literature anchors. The second is the renal and cognitive context. Renal function and cognition do not change overnight; they change slowly enough that the annual review is the right cadence to track them, and the care team holds the conversation about whether the review cadence should step up. The third is polypharmacy. Medications added by another specialty (cardiology, gastroenterology, the GP for sleep, the consultant for thyroid) can interact with insulin sensitivity or with hypoglycaemia recognition; the diabetes team holds the conversation about whether any new medication needs a settings review.

The two parts that follow walk through these foundations and shifts in the shape they take for the active reader (Part 1) and for the reader where the household is starting to do more (Part 2). The order is reader-led; the foundations and floors are the same in both.