Clinical case · Diabetes in older adults
Found on the kitchen floor at dawn
An 84-year-old man with diabetes, frailty and memory problems is found confused on the floor with a glucose of 2.4 mmol/L. Find the cause, set a safer target and simplify his treatment.
Intermediate 15 minNeeds clinical review
You will learn to
- Recognise overtreatment and hypoglycaemia as a cause of falls and confusion in frail older people
- Set an HbA1c target by function and frailty rather than age
- De-intensify treatment: stop long-acting sulfonylureas, adjust for kidney function and nutrition, and simplify
Presentation
Step 1 of 10An 84-year-old man was found by his daughter at 5 a.m. on the kitchen floor, sweaty and confused. The ambulance crew measured his capillary glucose at 2.4 mmol/L and gave intravenous glucose; he became alert within minutes.
He has a bruised left hip, but an X-ray shows no fracture.
References
- Boccardi V, Bahat G, Balci C, et al. Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)—Special Interest Group in Diabetes. Eur Geriatr Med. 2025;16(4):1231–1247. doi:10.1007/s41999-025-01168-1 · PubMed 40014274
- Bolt J, Carvalho V, Lin K, Lee SJ, Inglis C. Systematic review of guideline recommendations for older and frail adults with type 2 diabetes mellitus. Age Ageing. 2024;53(11):afae259. doi:10.1093/ageing/afae259 · PubMed 39572394
Last updated 2026-10-21.
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