INS and Hyperglycemia: Older patients with diabetes of long duration are more likely to need insulin therapy and are at increased risk for hyperglycemia, severe hypoglycemia, and glucose variability and have a higher prevalence of impaired hypoglycemia awareness.5–10 The increased risk of severe hypoglycemia among patients ≥65 years occurs with both intensive insulin regimens and with less intensive insulin regimens or oral antidiabetic medications.11–13