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Managing type 1 diabetes in frailty
  1. Sagen Zac-Varghese1,
  2. Bev Summerhayes1 and
  3. Peter Winocour2
  1. 1Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, UK
  2. 2Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Welwyn, UK
  1. Correspondence to Dr Sagen Zac-Varghese; sagen.zac-varghese{at}


Managing type 1 diabetes in frail elderly people can be logistically challenging, particularly for those living alone. District nurse visits are unpredictable and coincide poorly with meal time insulin regimes. Elderly people, particularly those with dementia, have variable oral intake and activity. For some, poor glycaemic control leads to frequent and prolonged inpatient admissions. The use of technology, such as flash glucose monitoring, and the use of analogue insulins can be helpful in this setting. Increased monitoring enables more accurate titration of insulin doses and the information can be accessed by healthcare professionals and carers remotely. Longer lasting analogue insulins allow for a greater margin of error in the timing of insulin administration.

  • Diabetes
  • Long term care

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  • Contributors SZ-V and BS developed the care plan for the patient. SZ-V wrote the manuscript. PW reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests SZ-V is an Affiliated Assistant Professor, University of Cambridge; Honorary Lecturer, Imperial College London and Visiting Lecturer, University of Hertfordshire. PW has received honoraria for delivering educational meetings and/or attending advisory boards for AstraZeneca, Eli Lilly, Novo Nordisk, Sanofi, MSD, Janssen and Vifor Pharmaceuticals.

  • Provenance and peer review Not commissioned; externally peer reviewed.