Complications from diabetes can change and worsen as you age. This can include your vision, nerve damage in your feet and toes, possible frozen or aching joints, or other complications affecting your organs.

As you age with type 1 diabetes (T1D), the diabetes complications you experience can evolve because of both natural aging and long-term effects of the condition and blood sugar levels.

That means someone in their 20s and in their 60s could both have T1D and the same diabetes complications, but they can differ in how each person experiences them.

Those growing older with the autoimmune condition and diabetes complications begin experiencing “geriatric syndrome,” which happens when the older adult’s body starts developing frailty or reduced healing because of their age. This can make existing diabetes complications more severe or difficult to manage.

Explore more on type 1 diabetes and how you can manage and live with this autoimmune condition.

In younger years, the focus is almost entirely on diabetic retinopathy, or damage to retinal blood vessels as a complication of higher blood sugars over time.

As you get older, the eye-related risks expand to include age-related conditions that appear earlier and progress faster in people with T1D. This includes:

  • Accelerated cataracts: People with T1D often develop cataracts decades earlier than the general population. High glucose levels cause the lens to swell and proteins to clump more rapidly.
  • Glaucoma risk: The risk of open-angle glaucoma increases with age and duration of diabetes.
  • Macular edema: While retinopathy can be stable for years, aging often brings a breakdown in the blood-retinal barrier, leading to swelling in the center of the vision (macula), which can cause permanent “blank spots” from macular edema.

In early adulthood, neuropathy often manifests as “pins and needles” in the feet or toes, possibly a burning sensation or sharp pain.

As you age, the damage typically evolves into numbness and autonomic dysfunction.

  • Hypoglycemia unawareness: This is one of the most dangerous evolutions. Over decades, the nerves that trigger the “fight or flight” response to low blood sugar (shaking, sweating) wear down. Older adults may drop to dangerously low levels without any warning.
  • Digestive and bladder nerves: Gastroparesis (delayed stomach emptying) can worsen, making insulin timing nearly impossible. Nerve damage to the bladder can lead to urinary retention and frequent UTIs.
  • Balance: The combination of muscle loss (sarcopenia) and loss of sensation in the feet significantly increases fall risks in those who are older with T1D.

Aging with T1D often leads to “stiff man syndrome” or cheiroarthropathy.

  • Limited joint mobility: Years of high blood sugar cause “advanced glycation end products” (AGEs) to build up in collagen. This makes tendons and joints thick and stiff.
  • Frozen shoulder: This condition affects your shoulder, leading to pain and stiffness. This is more common in older people with T1D. The “frozen” state can last longer and be more resistant to physical therapy than in those without diabetes. It can come and go, and worsen over time. This might require physical therapy or surgery to correct.
  • Trigger finger: Much like frozen shoulder, trigger finger is also more common in people who’ve gotten older with T1D. This can cause your fingers to freeze up and lock, often resulting in a “clicking” sound and your finger becoming stuck in a trigger-pulling position. This may require surgery or physical therapy to help address.
  • Bone health: While type 2 is often associated with higher bone density, T1D is also tied to lower bone density. As you age, this increases the risk of osteoporosis and “fragility fractures” from even minor falls.

As you get older with T1D, kidney health becomes even more important.

  • Kidney function: Natural aging reduces kidney function (GFR) by about 1 mL/min per year after age 40. In T1D, this decline is often doubled or tripled.
  • Protein leakage: As the filters (glomeruli) scar over decades, the amount of protein (albumin) leaked into the urine typically increases, which in turn accelerates damage to the heart.

Some in the diabetes medical community note that kidney disease (nephropathy) may follow a “quiet” progression for 20 to 30 years before hitting a tipping point in older age.

Keeping regular appointments with your healthcare and diabetes care team is an essential part of your management as you age, including routine lab tests to assess your kidney health.

For people with diabetes, the risk of cardiovascular disease (CVD) is significantly higher than those those without the condition. This risk rises as you get older, including for people with type 1.

  • Arterial stiffness: T1D causes premature aging of the blood vessels. By the time someone with T1D is 50 years old, the arteries may stiffen to the point of resembling a 70-year-old’s arterties.
  • Silent heart attacks: Because of the nerve damage mentioned above (autonomic neuropathy), older adults may not feel the typical chest pain of a heart attack, leading to delayed treatment.
  • Sudden cardiac arrest: Research shows the risk of sudden cardiac death is notably higher in people with T1D as they age, often due to a combination of silent ischemia and electrolyte imbalances from kidney issues.

While blood sugar management remains a key and critical part of T1D life no matter your age, it remains important the older you get.

As complications develop or progress — including nerve damage that can lead to less awareness of hypglycemia or other symptoms — you may need to adjust target glucose and A1C levels from when you were younger with T1D.

Different medications may also not work as well or in the same way that they did previously, which means discussion with your healthcare team becomes more important. They can best guide you on managing diabetes and related complications, as well as any changes in treatments or possible other options to consider.