What Are Target Blood Sugar Levels for Older Adults?

Your blood sugar naturally goes up with age, which increases your risk of type 2 diabetes. In fact, more than 20% of the people diagnosed with the disease are over age 65—that's more than any other age group.

Blood sugar (glucose) targets for those over 65 are less strict than those for younger people. The diabetes management plan may also be different.

This article looks at the challenges of managing diabetes after 65, blood sugar targets, how to monitor your glucose, and the benefits of dietary changes and medication.

Concerned nurse checks patient's blood sugar

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Blood Sugar and Diabetes Risk

Low blood sugar is called hypoglycemia. It is defined as a blood glucose level lower than 70 mg/dL (milligrams per deciliter). It can help diagnose diabetes or prediabetes (where sugar levels are high but not high enough to be diagnosed as type 2 diabetes).

Blood tests can measure glucose levels either while your stomach is empty (fasting values) or after eating (post-prandial values). The tests cannot diagnose diabetes on their own, but they can provide the evidence needed to warrant further testing if diabetes is suspected.

Category Fasting Values
(after 8 hours of not eating)
Post-Prandial Values
(2 hours after eating)
Normal 70-90 mg/dL Less than 140 mg/dL
Prediabetes 100-125 mg/dL  140-180 mg/dL
Diabetes Over 125 mg/dL Over 200 mg/dL

Hypoglycemia is common in older adults with diabetes. This may be due to other health concerns, such as other chronic illnesses, malnutrition, or multiple medications. The risk of diabetes complications increases with age.

Hypoglycemia can also result from taking too much diabetes medication. Overtreatment is common in older adults.

Target Blood Sugar Levels in Older Adults

When you're over 65, you have different diabetic treatment goals than younger people. Having other health conditions and/or cognitive impairment affects your blood sugar targets.

If you're in good health, you may be able to manage diabetes as if you were younger. If you have other health problems, less strict management can help you avoid hypoglycemia.

Conditions Co-Occurring With Diabetes Cognitive Impairment Target HbA1C Target Fasting Target Bedtime
None or few illnesses None or mild 7.5% or less 90–130 mg/dL 90–150 mg/dL
Multiple illnesses Mild to moderate 8% or less  90–150 mg/dL 100–180 mg/dL
One or more late-stage illnesses Moderate to severe 8%-9% 100–180 mg/dL 110–200 mg/dL

Monitoring Blood Sugar in Older Adults

Monitoring blood sugar regularly is crucial to diabetes management. You check your blood sugar with a device called a glucometer.

First, you prick a fingertip with a small needle called a lancet. Then you place a drop of blood on a test strip in the glucometer. After a few seconds, you'll get a number.

Generally, blood sugar should be checked before meals and at bedtime. Your healthcare provider may want you to check more or less often.

The following chart outlines what blood sugar levels should be for older adults (age 50 and over) in the hours following a meal as well as when levels are either too high or too low.

Level 0-2 hours after a meal 2-4 hours after a meal 4-8 hours after a meal
Dangerously high Over 300 mg/dL Over 200 mg/dL Over 180 mg/dL 
High 140-220 mg/dL 130-220 mg/dL 120-180 mg/dL
Normal 90-140 mg/dL 90-130 mg/dL 80-120 mg/dL
Low 80-90 mg/dL 70-90 mg/dL 60-80 mg/dL
Dangerously low 0-80 mg/dL 0-70 mg/dL 0-60 mg/dL

Cognitive decline and chronic illnesses can make it hard to follow your diabetes care plan. That can happen even if you've successfully managed it for years.

In these situations, your healthcare provider may:

  • Prescribe a lower dose of medication
  • Involve your caregivers in monitoring
  • Carefully watch you for low blood sugar

Nutritional Therapies

Diet is also 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.

Medical Nutritional Therapy

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 Options

The medication you take to help control blood sugars may interact negatively with other drugs or supplements you take.

Healthcare providers have to balance effectiveness with the risk of hypoglycemia and drug interactions. They have a lot of medications to choose from.

DPP4 Inhibitors

DPP4 inhibitors lower your risk of hypoglycemia. 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.

Medications in this class include:

  • Sitagliptin
  • Saxagliptin
  • Linagliptin
  • Alogliptin

SGLT2 Inhibitors

SGLT2 inhibitors also reduce hypoglycemia risk. Some drugs in this class may be a good option if you have heart disease. Side effects can include:

  • Kidney impairment
  • Bone loss
  • Low blood pressure

Some SGLT2 inhibitors are:

  • Dapagliflozin
  • Canagliflozin
  • Empagliflozin

GLP1 Agonists

GLP1 agonists are given by injection, either daily or weekly. Examples of these drugs are:

  • Exenatide
  • Exenatide ER
  • Liraglutide
  • Albiglutide
  • Lixisenatide
  • Dulaglutide
  • Semaglutide

Exenatide ER and albiglutide preparation can be time-consuming. Possible side effects are:

Digestive side effects like decreased appetite can lead to a dangerous amount of weight loss in older people.

Dual-Acting GLP-1 and GIP Receptor Agonists

In May 2022, the Food and Drug Administration (FDA) approved the once-weekly injection, Mounjaro (tirzepatide). Mounjaro is the only dual-acting GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonist approved to improve glycemic control in adults with type 2 diabetes in addition to diet and exercise.

Mounjaro may cause thyroid cancer. Do not use Mounjaro if you or any of your family members have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).


Hypoglycemia becomes more likely when you're over 65. Blood sugar goals are looser to help curb that risk. Frequent blood sugar checks can help prevent it, too.

Diabetes is managed through diet and medications. Managing your diet can get harder with age and failing health. Your healthcare provider may suggest medical nutrition therapy.

Many drugs can help manage diabetes. Your provider can choose the one that's safest for you based on your individual needs and health status.

A Word From Verywell

It’s normal for your diabetes management to change with age. Follow the treatment plan laid out for you by your healthcare provider(s). Remember that your target numbers may be higher than those for other age groups.

If you need help managing your diabetes, speak up. Your care team is there to guide you and help you find the resources you need.

Frequently Asked Questions

  • Should I be tested for diabetes?

    The American Diabetes Association recommends routine screenings for type 2 diabetes every three years for everyone after age 35. You may need them sooner or more frequently if symptoms develop, or if you have or develop risk factors such as high blood pressure or obesity.

  • What are the symptoms of high blood sugar?

    Symptoms of hyperglycemia (high blood sugar) include:

    • Shakiness, nervousness, or anxiety
    • Sweating and chills
    • Irritability
    • Confusion
    • Rapid heartbeat
    • Dizziness
    • Fatigue and weakness
    • Blurred vision
    • Headaches
    • Clumsiness
    • Seizures

  • Is diabetes sometimes missed in older adults?

    Researchers say hypoglycemia is likely underreported in adults over 65. That may be because they don't always have symptoms. Also, cognitive impairment may cause difficulties communicating about symptoms with caregivers.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Carisa Brewster
Carisa D. Brewster is a freelance journalist with over 20 years of experience writing for newspapers, magazines, and digital publications. She specializes in science and healthcare content.