Hi Ann, if your MIL is in frail health and has had diabetes for 42 years, what is your goal for her, what can she do herself and what are you willing to manage? In elderly patients, any co-morbidities and cognitive challenges are also considered in a treatment plan. The A1c level is allowed to be higher, up to 8% in elderly with diabetes. If you change the insulin but if she can’t manage hypos on her own, you need to be monitoring them. As the NP told you, an average of 150-160 may be the best in her circumstances.