What Are Blood Sugar Levels for Older Adults?

Older adults have a higher risk of developing diabetes, with type 2 diabetes being the most common among this age group. At 21.4%, older adults aged 65 and older have the largest share of diabetes diagnoses of all age groups.

The American Diabetes Association recommends that adults over 45 start getting screened for diabetes and prediabetes every one to three years even if results remain normal. Even with successful diabetes management, the risk of complications due to blood vessel damage increases with age.

Symptoms of diabetes are the same across age groups, which can include increased thirst, fatigue, and vision problems. However, the blood sugar target for the elderly is less strict compared to the ideal range for other age groups. The diabetes management plan for older adults may also be different.

Concerned nurse checks patient's blood sugar

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Managing Diabetes Over Age 65

Hypoglycemia happens when your blood sugar levels are lower than normal. It is defined as a blood sugar level of lower than 70 mg/dL.

It is common among older adults with diabetes. This could be due to the fact that the elderly are more likely to have other chronic conditions, malnutrition, or take multiple medications.

Hypoglycemia can also result from taking too much of the medication used to lower blood sugar. Overtreatment of diabetes in older adults is common.

Researchers say hypoglycemia is likely underreported because the elderly may not experience the symptoms of low blood sugar or they may not be able to communicate their feelings to their caregivers due to cognitive impairment.

Blood Sugar Levels

Diabetic treatment goals for older adults over 65 are different from those for younger adults and children. To avoid hypoglycemia, patients with multiple chronic conditions, or who have a terminal diagnosis, can manage their blood sugar less strictly. Older adults in more stable health can manage their diabetes with tighter control.

Target Blood Sugar Levels in Older Adults over 65
Health Status A1C Fasting Blood Sugar Bedtime Blood Sugar
No or few chronic health conditions, cognitively functional 7.5% or less 90–130 mg/dL 90–150 mg/dL
Multiple chronic conditions, mild to moderate cognitive impairment 8% or less  90–150 mg/dL 100–180 mg/dL
Living in a long-term care facility, end-stage chronic illness, moderate to severe cognitive impairment 8% to 9% 100–180 mg/dL 110–200 mg/dL

Monitoring Blood Sugar

Monitoring blood sugar regularly is an important part of any diabetes management plan. Blood sugar checks are done with a small needle called a lancet, which is used to prick the tip of your finger. A drop of blood is placed on a test strip and a glucometer will show your blood sugar level. Generally, blood sugar should be checked before meals and at bedtime. A healthcare provider may advise checking more often.

Cognitive decline and chronic illnesses can make it difficult for some older adults to safely follow their diabetes care plan, even when they have been successfully managing their condition for years. In these situations, a healthcare provider may prescribe a lower dose of medication, involve caregivers in monitoring, and carefully assess for low blood sugar.

Nutritional Therapy

Medication is just one tool for diabetes management. Diet is another way people with diabetes can manage their condition because eating, or not eating, is what impacts blood sugar.

However, maintaining a healthy diet can be a challenge for some older adults due to the gastrointestinal issues that come with increasing age, which can make it difficult to eat and put them at risk for poor nutrition.

These issues can include:

  • Swallowing disorders
  • Anorexia
  • Indigestion and other bowel issues
  • Feeling full too soon after eating

Medical Nutritional Therapy

Older adults may need to add medical nutrition therapy to their diabetes treatment plan. This is done under the guidance of a registered dietitian who creates a tailored nutrition plan that addresses issues that make it hard to eat.

Some strategies may include:

  • Adding supplements, protein, or liquid calorie boosters to maintain weight
  • Loosening food restrictions
  • Assisting with food prep, meal intake, grocery shopping, or macronutrient counting

Medication

Older adults still need medication to help control blood sugar. They’re usually taking multiple medicines for other chronic conditions, so healthcare providers must be cautious in choosing a safe and effective diabetes medication with the lowest risk for hypoglycemia and drug interactions.

The most common therapies include:

  • DPP4 inhibitors (sitagliptin, saxagliptin, linagliptin, alogliptin): One pill daily will help lower the risk of hypoglycemia. Watch out for heart failure (saxagliptin and alogliptin) and dose modification with poor renal function.
  • SGLT2 inhibitors (dapagliflozin, canagliflozin, empagliflozin): One pill daily will lower the risk of hypoglycemia. Empagliflozin is a good option for people with heart disease, and can help reduce the risk of cardiovascular death in those with type 2 diabetes. However, this medication may come with significant side effects, including renal impairment, decreased bone density, and low blood pressure.
  • GLP1 agonists (exenatide, exenatide ER, liraglutide, albiglutide, lixisenatide, dulaglutide, semaglutide): Doses are administered by daily or weekly injections. Exenatide ER and albiglutide preparation can be time-consuming. Possible side effects include nausea, diarrhea, weight loss, and pancreatitis. Sometimes gastrointestinal side effects like decrease in appetite can be sensitive for the elderly and cause significant weight loss.

A Word From Verywell

It’s completely normal for diabetes management and treatment to change as a person gets older. Whether someone is newly diagnosed or has had diabetes for decades, there are many options to keep blood sugar levels within normal range and maintain a good quality of life.

It's important to note that the blood sugar targets for people who are older are different from those for people in younger age groups. Similarly, their treatment plan may be different, and older adults may need more help to adhere to blood sugar monitoring and treatment. Always consult with a healthcare provider before making any changes to your treatment plan.

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7 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.
  1. Centers for Disease Control and Prevention. National diabetes statistics report 2020. Updated February 11, 2020.

  2. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS. Diabetes in older adults. Diabetes Care. 2012 Dec;35(12):2650-64. doi:10.2337/dc12-1801

  3. Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, Sinclair AJ. Hypoglycemia in older people - a less well recognized risk factor for frailty. Aging Dis. 2015 Mar 10;6(2):156-67. doi:10.14336/AD.2014.0330

  4. Medline Plus. Hypoglycemia. Updated January 2, 2017.

  5. Leung E, Wongrakpanich S, Munshi MN. Diabetes management in the elderly. Diabetes Spectr. 2018 Aug;31(3):245-253. doi:10.2337/ds18-0033

  6. Cleveland Clinic. Monitoring your blood sugar. Updated September 17, 2018.

  7. Stanley K. Nutrition considerations for the growing population of older adults with diabetes. Diabetes Spectr. 2014 Feb;27(1):29-36. doi:10.2337/diaspect.27.1.29