How to relax the targets 

As people get older, quality of life and avoiding low glucose levels is much more important than worrying about high glucose levels. 

There are several ways to relax the targets – the suggestions below are only ideas and an individualised programme should be devised with the diabetes team. This plan should be reviewed regularly to make sure it is working. 

Learn about ways people can relax their targets: 

Carbohydrate counting 

If someone is carbohydrate counting then the ratio can be changed so that they take less insulin with each carbohydrate meal. If using a smart meter, the ratio can be changed on the meter/ app. If manually calculating, the ratio can be changed in a similar way, for example from 1 unit per 10 grammes to 0.5 units per 10 grammes. 

Reduce fixed doses 

If someone is on fixed doses of insulin then the dose with each meal can be reduced. 

Reduce long acting dose 

Reducing the long acting dose of insulin can allow the average glucose level to drift up a bit. It may be necessary to reduce the long acting and the short acting insulin as above.

Stop mealtime insulin 

If someone’s appetite has reduced and they are eating very little carbohydrate and becoming quite frail, it may be acceptable to stop the meal time insulin altogether. Long acting insulin with one or two extra meal time injections per day if the glucose is rising may be sufficient. However, it is strongly recommended that this is decided with a diabetes team. Stopping mealtime insulin may mean that blood glucose tests are needed in the morning and at night to make sure the sugars aren’t creeping too high. 

If blood glucose tends to rise, on occasion, whilst on long acting insulin only, it is possible to give occasional small corrections of short acting insulin when required. A sensible, written scale can be devised to help work out those correction doses. 

Reduce the number of blood tests 

It may be acceptable to reduce the number of glucose tests taken each day. This may cause some distress in people who are used to paying very close attention to their diabetes. It may be OK to test just once or twice a day if the doses of insulin have reduced significantly and someone is becoming progressively more unwell and frail. 

The HbA1c

It is important to aim for a higher average blood glucose level – the Hba1c. Levels of 8.5% (69mmol/mol) or even higher may be appropriate. 

Targets may need to be continually reviewed, particularly if someone is becoming increasingly unwell and frail. However, age itself is not necessarily a reason to relax diabetes control – there are plenty of eighty-year-olds touring Europe and overseas! 

It is very important to remember that someone with type 1 diabetes should not stop their insulin altogether, however, it may be sensible to relax the demands that are put on them as they become older and more frail. 

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