This chapter emphasis on geriatric diabetes. The most accepted diagnostic tool for confirming the diagnosis of diabetes mellitus is the World Health Organization endorsed oral glucose tolerance test. Elderly people are susceptible to develop hypoglycemia due to inherent age-associated physiological changes such as a decrease in hepatic oxidative enzyme activity, loss of counter-regulatory response, the concomitant decline in renal function, autonomic dysfunction and hypoglycemic unawareness. Selection of drugs in pharmacological intervention, insulin therapy in the elderly, therapeutic lifestyle changes, nutritional therapy and physical exercise are well explicated. The primary principle of diabetes therapy in the geriatric population should be to attain euglycemia, without causing hypoglycemia. The clinician in charge should keep in mind that while the primary aim of treatment is adding years to the life of the elderly subject, adding life to existing years is also no less important. A shared healthcare approach including counselors, clinician, nutritionists and social workers is also critical. To this end, using all pharmacotherapy with utmost caution is most important.