One third of the population above 70 has a diabetic-like metabolic status. Diabetes-induced diseases as well as acute blood sugar imbalances have great impact on quality of life. Transferring the known disease management regimes from adults to the elderly is only possible to a limited extent. For patients needing short-term or long-term care, the clinical practical guidelines should, therefore, be adapted to the medical care situation. The favored live-style modification with change of nutrition or increased activity is limited by multimorbidity in the elderly. Medical therapy should be adjusted to 6.6-10.0 (11.1) mmol/l glucose. Hypoglycemia must be avoided, whereas elderly patients with HbA(1c) values above 8% also requires insulin treatment. Simple treatment and the involvement of family members or informal caregivers are the basis of good diabetes treatment in old patients.