The older adults afflicted with diabetes differ from their younger counterparts in the heterogeneity of their presentation, early physiologic aging, presence of some of the age related problems, inability to regulate their medication and poor social support system in some cases, and a higher likelihood of exposure to surgery and anaesthesia. The aim of perioperative management is not only to obtain a good glycemic control but also to remember that the surgical outcome of diabetics is not very different from non-diabetics if the diabetic induced end-organ involvement (which may be more in some of the older adults) is looked for carefully and managed properly. There are many regimens but the anaesthesiologist has to himself define his perioperative goals, devise a simple regimen to achieve these goals within the constraints of the setup she/he has and the needs of the particular clinical situation, and accordingly adjust the intensity of monitoring. The recent changes in the classification and diagnostic criteria of DM, and identification of clinically important implications of even a temporary perioperative good control of DM apply equally well to this population of older adults. In fact, a visit to hospital for anaesthesia and surgery may give them an opportunity to learn, under expert supervision, the methodology of achieving tight control which they may follow even later, thereby improving the further course of the disease!