Aging With Type 1 Diabetes: Long-Term Care, Cognitive Changes and Who Will Care for Us

Fortunately, modern insulins and advancing technology now allow people to reach older age, including those diagnosed after 65, but support for this growing population remains limited.

A New Stage For Long-Term Type 1 Diabetes

As more adults reach their 60s, 70s, and 80s with T1D, a life stage is emerging that the healthcare system has not yet fully defined. Long-term T1Ds have lived through multiple eras of treatment, from early insulin to today’s automated insulin delivery (AID) systems. But few resources explain what decades of diabetes management mean for aging bodies, daily routines or long-term health.

Most diabetes education still centers on children, teens and newly diagnosed adults. 

Many long-term T1Ds describe feeling like pioneers — aging with type 1 diabetes in a world that was never designed with them in mind.

New Challenges In Older Bodies

As people age, type 1 diabetes can change how daily tasks feel. Tasks that once felt simple may now require more time, focus or effort.

Changes in eyesight and hearing can make it harder to read pump screens, pen dials or syringe markings. Device alarms may be missed. Numbness or pain in the hands can impair the ability to open packaging, peel adhesive labels, or press small buttons.

Skin health can change after decades of injections, infusion sets, and continuous glucose monitor (CGM) use. Scar tissue, skin firmness, and reactions to adhesives can reduce the number of available sites. Many long-term T1Ds rotate carefully yet still feel as if they are running out of usable real estate. 

Because insulin absorption depends on healthy tissue, doses may begin responding differently over time.

Other health conditions often appear alongside diabetes, including heart disease, kidney problems and autoimmune disorders like thyroid and celiac disease. Some age-related issues may show up earlier in people living with T1D. Medications increase, as do appointments and procedures.

Older adults may also experience greater hypoglycemia unawareness, making low blood sugars harder to detect until they become severe. 

Financial stress can increase with age. Retirement often means losing private insurance and experiencing a drop in income. Even with Medicare, out-of-pocket costs for insulin, sensors, pump supplies and other medications can remain high. Greater contact with the health system also means more copayments, travel, and time.

Cognitive changes may also develop. Some older adults notice more forgetfulness or slower thinking like: 

 • Missing a dose or taking an extra one
• Losing track of insulin on board
• Feeling overwhelmed by pump menus
• Struggling with carbohydrate counting
• Forgetting to charge an insulin pump, for devices that require charging

Research suggests that diabetes and frequent hypoglycemia may increase the risk of cognitive decline. Not everyone will experience these shifts, but memory and cognition become important components of care as people age.

This all sits on top of the daily work of staying within range, avoiding severe lows, and planning for meals, driving, and getting enough sleep.

When Loneliness Rises With Age

Loneliness can affect anyone, but it often increases later in life. Retirement, the loss of a partner or friends, changes in mobility, moving, and spending more time at home can all shrink a person’s world.

In 2023, U.S. Surgeon General Vivek Murthy warned that chronic social disconnection can raise the risk of early death to levels similar to smoking many cigarettes a day. For people aging with T1D, this emotional weight adds strain to an already demanding condition. Loneliness is not the only challenge, but it can make everything else feel heavier.

Social Isolation Versus Loneliness

Social isolation refers to having few social contacts. Loneliness is the feeling of being disconnected, even when people are around. Both matter. Someone can live with family and still feel profoundly lonely if no one understands the daily work of T1D. For older adults managing insulin, devices and age-related changes, that emotional gap can have real health consequences.

The World Health Organization (WHO) also identifies social connection as a key part of healthy aging and warns that loneliness is a major risk factor for early death, similar in scale to other leading health risks.

Hospitals And Long-Term Care Are Not Ready

At some point, adults may require more assistance at home or choose to move to an assisted living facility, a retirement community, or a nursing home. This transition often brings a new kind of fear.

Most hospitals and long-term care settings are not trained in modern T1D management. Staff may be familiar with sliding-scale insulin or oral medications for type 2 diabetes, but not with the needs of T1D, such as:

 • Basal and bolus dosing
• Carb ratios and correction factors
• Continuous glucose monitors (CGMs)
• Insulin pumps that run continuously

In practice, this can result in missed alarms, inappropriate dose changes, or requests to stop using pumps. Some facilities charge additional fees for diabetes support services. Others call 911 for lows that could be treated on site.

Even large hospitals struggle with T1D care, so it is not surprising that assisted living and nursing homes often feel unprepared. 

People often ask, “Who will take care of me when I can’t do this myself?”

When The System Falls Short: Helen And Her Dad

Helen, who has lived with type 1 diabetes for 45 years, shared what happened to her father, who also lived with the condition.

He lived in an assisted living facility a few hours away. Each time they spoke, she inquired about his diabetes care and encouraged him to seek help when something seemed wrong. He was gentle and hesitant to complain.

It became clear that the staff did not understand his Dexcom G6. Alarms were missed, and glucose data were not consistently used in his care. Workers sometimes discarded his transmitter, not realizing it was required for the next sensor. No one took the time to learn the system or follow a consistent plan.

To Helen, it felt as if the facility was doing only the minimum to keep him stable, not helping him live safely with a complex condition. She said he seemed to be there to die, not to receive thoughtful care. He later passed away, and she believes he was not properly supported.

The Missing Roadmap For Aging With Type 1 Diabetes

Stories like Helen’s show a larger gap. Adults entering older age with T1D are stepping into a chapter with little guidance and few trained care environments.

Most long-term studies follow people for only two decades. Yet thousands have now lived with T1D for 40, 50 or even 70 years. There is limited research on how lifelong insulin use, glucose variation, aging-related health conditions and cognitive changes interact. Little is known about the long-term effects of pumps, CGMs, adhesives and repeated scarring on insulin absorption.

People aging with T1D need care models, planning tools and clinical training that reflect their lived experience.

A Visibility Gap For Older T1D Adults 

Representation in diabetes campaigns and education programs rarely includes people aging with T1D. National organizations often focus on childhood onset, new diagnoses, or technology adoption, rather than the realities of later life or diagnoses after age 65.

This lack of visibility has consequences. Adults may not know where to find age-specific guidance or what changes to expect. Their decades of experience are rarely included in research, policy, or clinical guidelines.

Recognizing this gap and elevating the voices of people who have managed T1D the longest is essential for improving care.

Planning Ahead With Type 1 Diabetes

While systems evolve, people can take steps now to prepare for later-life diabetes needs. Bringing aging into medical appointments can open important conversations. 

Questions to ask include:

• What should I expect as I get older with T1D?
• How can I lower my risk for severe lows in the next five to ten years?
• If my vision, memory or dexterity changes, how can we simplify my insulin plan?
• Is my current pump or CGM still the best choice?
• What are my target blood glucose and time-in-range goals?

A simple backup plan can also help. It may list:

• Usual insulin doses and correction factors
• How to treat low blood sugars
• Basic pump or CGM instructions
• Pharmacy and supply information
• Emergency contacts and clinic numbers

Sharing this with a trusted person can make transitions safer during illness or hospitalization.

Choosing Where To Live

If someone is considering assisted living, a retirement community, or a nursing home, diabetes-specific questions can help determine whether the setting is equipped to meet the needs of individuals with diabetes. 

Questions include: 

• Are staff trained to support pumps and CGMs?
• Who can adjust insulin doses?
• How are low blood sugars treated?
• How often are glucose levels checked if technology fails?
• Does the facility work with an endocrinologist?

The answers can reveal how prepared a facility is to support someone who depends on insulin around the clock.

Finding Connection And Peer Support

Formal programs for people aging with T1D are limited, but peer support is growing. Communities built by people with lived experience offer connection, shared understanding and practical guidance for life with T1D in later years.

Some options include:

Grownup T1Ds 

Grownup T1Ds, a U.S.-based nonprofit offering in-person social events and peer support for adults in midlife and older in multiple cities. Gatherings help reduce isolation, ease burnout and support emotional well-being.

Connected in Motion’s Platinum Club

Connected in Motion’s Platinum Club, an online group for adults 55 and older. Members meet to talk about aging with T1D and learn from peers and guest experts.

T1D to 100

T1D to 100, a volunteer-led community sharing stories about long-term life with T1D and offering resources focused on aging, independence and quality of life. 

Mixed-age Support Groups

Mixed-age support groups and online forums can also provide a connection. Some individuals benefit from working with a therapist who is familiar with chronic illness and aging.

A Call To Pay Attention

Reaching older age with type 1 diabetes is becoming more common, yet support systems still lag behind. Adults in this stage often feel isolated within a medical landscape not built for them.

Their stories show what is at stake when long-term diabetes care meets aging bodies, unprepared systems and limited guidance. 

Listening to those who have lived through every era of treatment is essential for building better support. For people aging with T1D, connection and clear guidance are not extras–they are safety.