Management of patients with dementia differs from the management of cognitively intact patients. Although dementing illnesses are progressive, the course of dementia should be managed consistently through appropriate therapeutic efforts in order to maintain cognitive function. Irregularity of meals due to impaired cognitive function results in more frequent hypoglycemic episodes, in particular hypoglycemic coma. To prevent such episodes, less intensive glycemic targets should be set, but the risks of both hyperglycemia and hypoglycemia must be considered for each individual and the participation of caregivers is required in developing a treatment strategy. Overall, in the management of demented diabetic patients, a team approach is required and preservation of patient self-esteem is of great importance.