Tight glycemic control in the elderly diabetic patient can drastically alter the patient's life-style. A balanced approach allows somewhat higher plasma glucose levels while preventing the serious acute complications of poor glycemic control. Sulfonylureas are the agents of choice in most elderly type II diabetic patients when fasting plasma glucose cannot be maintained below 140 mg/dl with diet and exercise. Consider insulin therapy when symptomatic fasting hyperglycemia above 200 mg/dl persists.