What Are Blood Sugar Levels for Older Adults? (2024)

Target Blood Sugar Levels in Older Adults

To determine whether your blood sugar is on target, your healthcare provider will monitor multiple readings.

• Hemoglobin A1C: Known as A1C or HbA1C, this blood test shows your average blood sugar over the last few months, rather than at a fixed point in time.
• Fasting glucose: Your blood sugar level after not eating for at least eight hours.
• Bedtime glucose: Your blood sugar level at the end of the day.

Your target A1C levels will vary depending on your overall health and impairments of instrumental activity of daily living (IADL), which are the skills needed to live independently such as using the telephone, shopping, preparing meals, housekeeping, etc.).

Healthy or with few underlying health issues (comorbidities)
Target A1C less than 7.5%
Fasting glucose: 90–130
Bedtime glucose: 90–150

Multiple chronic comorbidities or two or more (IADL)
Target A1C less than 8%
Fasting glucose: 90–150
Bedtime glucose: 100–180

Very poor health or end-stage chronic illness
Target A1C less than 8.5%
Fasting glucose: 100–180
Bedtime glucose: 110–200

Symptoms of Blood Sugar Problems

High blood sugar is called hyperglycemia. Hypoglycemia is defined as a blood glucose level lower than 70 mg/dL (milligrams per deciliter).

The two conditions occur for different reasons and are treated differently as well.

People diagnosed with high blood sugar may develop hypoglycemia as a result of taking too much diabetes medication. This type of overtreatment is common in older adults.

Diet and Blood Sugar

Diet is important for managing diabetes. Maintaining a healthy diet can be a challenge for some older people. That's because common gastrointestinal (digestive) issues can put you at risk for poor nutrition.

These issues can include:

• Swallowing disorders (dysphagia)
• Anorexia
• Indigestion and bowel issues
• Feeling full after eating very little

Keeping a food log can help you and your care team see what nutritional problems you may have.

Older adults may need to add medical nutrition therapy to their diabetes treatment plan. That's when a registered dietitian creates a nutrition plan tailored to your needs.

Some strategies may include:

• Adding supplements, protein, or liquid calorie boosters to maintain weight
• Loosening food restrictions
• Assistance with food prep, eating, grocery shopping, or watching your nutrition

Medication to Regulate Blood Sugar

Healthcare providers may prescribe medication to help control blood sugars.

• DPP4 inhibitors: These lower your risk of hypoglycemia. Medications in this class include Januvia (sitagliptin), Onglyza (saxagliptin), Tradjenta (linagliptin), and Nesina (alogliptin). Heart failure is a possible side effect of some drugs in this class. You'll need a lower dose if you have poor kidney function.
  
• SGLT2 inhibitors: These medications reduce hypoglycemia risk. They include Brenzavvy (bexagliflozin), Farxiga (dapagliflozin), Invokana (canagliflozin), and Jardiance (empagliflozin). Some drugs in this class may be a good option if you have heart disease because some research shows they offer protective cardiac effects. They do have other side effects including kidney impairment, bone loss, and low blood pressure.
• GLP-1 agonists: Given by injection, either daily or weekly, these drugs include Byetta (exenatide); Ozempic, Rybelsus (semaglutide); Saxenda, Victoza (liraglutide), Trulicity (dulaglutide). Possible side effects include nausea and vomiting. GLP-1 agonists may also raise the risk of pancreatitis.
  
• GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonists: These have been approved to improve glycemic control in adults with type 2 diabetes in addition to diet and exercise. The once-weekly GIP injection Mounjaro (tirzepatide) may cause thyroid cancer.
  

Summary

Hypoglycemia becomes more likely as you age. It's common for people to be diagnosed with type 2 diabetes in their late 40s and continuing into their 50s and beyond. The fastest-growing group of people with a diabetes diagnosis is age 65 and over.

The way in which diabetes is managed and treated also changes with age, the development of other health conditions, and medications you take. Blood sugar targets also change, though the need for careful monitoring remains.

Diabetes is managed through diet and medications. Your healthcare provider can recommend, diet, medication, and other changes to help you, including medical nutrition therapy. They also may evaluate your need for support if cognitive decline is a part of your overall health history.