Older adults needing more support, the work the household carries together

The reader, and the people around the reader

The reader of this part is sometimes the person living with type 1 diabetes, and sometimes the person next to them. The spouse who has learned how the pump alerts sound. The adult child whose phone now carries the CGM share. The district nurse who reads the line on a Tuesday morning. The care-home keyworker who knows where the glucagon is kept and what time the long-acting basal goes in. Naming the reader honestly, before any instruction lands, is the first work of this part.

The household and the care team around someone living with type 1 carry a real piece of the work. They are not a back-up. They are part of the diabetes system. The literature on family-centred and care-team-led T1D in this band is consistent: outcomes are better when the people around the reader are part of the conversation, when the named safety floors are explicit, and when the review cadence widens to include them where appropriate (ADA 2026 §13).

The sections that follow are written for both audiences. The reader living with the diabetes can read them as the foundations they already know, viewed from the household’s angle. The household member or care-team reader can read them as the named anchors that hold the work steady. Neither audience is the secondary one.

The named safety floors carry more of the weight

The same older-adult target floors named in Part 1 surface here as the central safety case rather than as the device sub-bullet. When the work of the diabetes moves into the household or the care team, the floor on the algorithm is the anchor that does not move. It is the target the system will not work below in this band, regardless of which set of hands is carrying the day-to-day work. Naming the floor at every review, and naming it again when the household or care team changes, is part of the conversation worth having.

The floors do not change the foundations. The reader’s TDD is still the reader’s TDD. The ICR the team has tuned is still the lever the algorithm leans on. The floor is the safety guard that holds while the household or the care team carries the day-to-day work.

Hypoglycaemia recognition when the reader cannot always self-report

The hardest pattern in this band is the low that the reader cannot describe. The Cryer 2013 IAH framework that the adult guide named is amplified by the named shifts of the older-adult band; impaired awareness of hypoglycaemia is more common in this band, particularly in readers with longer T1D duration. The lever for the household and the care team is recognising the pattern in someone who cannot always speak it.

The signs the household learns to recognise are the structural ones rather than the textbook ones. Quieter than usual. A slowness that does not match the time of day. A confusion at the end of a meal. A reluctance to do a routine the reader normally does without thought. A sweating that did not have a cause. Each is non-specific on its own; together they are the pattern the household catches before the CGM alarm catches it.

The household and care-team protocols that catch the low before it becomes an emergency are the conversation worth having with the diabetes team early. Nasal glucagon is licensed and easier for a non-clinician to deliver than the older injection kits; the team will know which option the local service issues. The CGM share permission set on more than one phone is the second protocol that the literature consistently flags.

Polypharmacy, renal function, and cognition, the three contexts the care team holds

The three named older-adult-band shifts that surfaced in Part 1 are the same three the care team holds in this part of the guide too. Polypharmacy, renal function, and cognition each become more relevant as the years accumulate, and each is a normal part of the work in this band rather than a sign of failure (ADA 2026 §13).

The care-team review cadence often steps up in this band. That is the system around the diabetes adjusting to the work that the system is carrying, not a signal that anything has gone wrong. A six-monthly review where the annual review was the default, a phone call between visits, a district nurse contact added to the team, a care-home keyworker briefing for new staff: each is a protocol the literature anchors. The lever for the reader and the household is asking for the cadence that fits the work being done; the lever for the team is the review that follows.

Cross-hub bridges, and the questions for the next review

The closing card on every part of the older-adults guide is a reader-led navigation card rather than a prescription. The female reader at any life stage in this band will find the female guide useful for the perimenopause and post-menopause arcs. The reader, or family member, who wants the foundations refresh will find the adults guide useful as a back-look. The reader supporting a younger family member with T1D will find the children and young people guide useful.

The questions for the next review are the same shape as in Part 1, with the household angle added. Bring the TDD and the last fortnight of CGM data. Bring the named safety floor for the system and confirm the team has it set. Bring the new medications added by another specialty. Bring the IAH question if the household has noticed lows the reader did not feel coming. Bring the cadence question if the work has widened and the review pattern has not. The team is the route through every settings conversation; the page is the route into the conversation, not the substitute for it.