Growing older with type 1 diabetes can take gettting used to. This may mean glucose goal adjustments, revisions to emergency treatment plans, and navigating mental health and complication changes.

We all get older, including people with chronic conditions like type 1 diabetes (T1D).

With newer modern advances in diabetes care, those with T1D are living longer and healthier than they historically did in the 20th century and early part of this century. That means people are becoming “T1D trailblazers” in many ways in their 60s, 70s, and beyond.

Managing the condition as you age requires shifting from a mindset of high intensity management to one of sustainability, safety, and complication prevention.

As we age, the risk of hypoglycemia unawareness increases, and the body’s ability to bounce back from a severe low diminishes.

  • Safety over perfection: Work with your endocrinologist to potentially loosen your A1C targets. While a 6.5% might have been the goal at 30 years, a goal of 7.0% or 8.0% may be safer in later years to prevent dangerous falls or cardiovascular stress caused by hypos. The American Diabetes Association’s yearly standards recognize this possibility for older adults, particularly those with hypo unawareness or existing diabetes complications that may make recognizing highs and lows more difficult. Always consult your healthcare team to discuss individual goals.
  • Time in range (TIR): Focus more on the time spent in target range rather than just the A1C average. Aiming for a steady line is often better for the aging brain and heart than “rollercoaster” numbers. Work with your diabetes care team to determine what TIR percentage may be best for you.

This may be a time to embrace more automated technology, including continuous glucose monitors and other diabetes tech tools. These may include:

  • Continuous glucose monitors (CGMs): This is viewed as one of the most important tools for managing T1Ds. They provide alerts for lows that you might not feel as sharply as you once did.
  • Smart pumps: Closed-loop systems (like Tandem Mobi/t:slim, Omnipod 5, or Medtronic 780G) can take the cognitive load off carbohydrate counting and basal adjustments, which is helpful if you experience diabetes burnout or age-related cognitive changes.
  • Mobile apps: While technology may have once been viewed as a younger person’s tool, mobile apps and smartphones have become mainstream for people of all ages. That includes those who’ve grown older with T1D, and may use that tech to help better manage and keep track of their diabetes routines.

T1D is technically an autoimmune disease, but as you age, it becomes a vascular challenge. This means other diabetes complications can increase or evolve over time, including those affecting your heart, kidneys, and other organs.

  • Blood pressure and cholesterol: Be proactive. Even slightly elevated blood pressure can accelerate diabetes-related retinopathy in the eyes or risk of heart attack and stroke.
  • Kidney health: Ensure you are getting annual UACR (urine albumin-to-creatinine ratio) tests to catch any changes in kidney function early, as medications may need dosage adjustments if kidney filtration slows down.

Cognitive decline or even just the “brain fog” of aging can make the math of T1D harder. That is why it is important to have people in your life who can support you in your daily diabetes management.

Managing documents ahead of time can become important as you age, and as you let people in your support network know where that information is kept.

Keep an In Case of Emergency binder. It should include your current pump settings and rates, your preferred hypo treatments, and contact info for your diabetes care team. Also include your current health insurance plan information and copies of your ID and cards.

If managing a pump becomes too complex, don’t view moving back to long-acting insulin pens as a failure. The goal is the most effective management with the least amount of stress.

Getting older with type 1 diabetes can be a daunting point in life.

This can mean changes to how you’ve lived with this autoimmune condition for years and even decades, including how you experience complications or everyday diabetes-related symptoms. Your abilities to navigate diabetes management may also evolve in the medications and technologies you take, and also with how you’re able to use those to manage diabetes.

Building a support network with family, friends, and others can be an important way to continue managing your health as you age.