What is Normal Blood Sugar Levels?

Depending on where you look, recommended blood glucose levels can vary. The American Diabetes Association (ADA) numbers differ from the American College of Endocrinology (ACE) guidelines. The ACE recommendations happen to be a bit more strict than the ADA's. If you are someone with diabetes, how do you know which to follow?

Be sure to ask your healthcare provider which goals are right for you.

Blood sugar targets should be individualized based on a variety of factors, including things like:

Age
Duration of diabetes
Life expectancy
Blood sugar control
Medicine
Pregnancy
Frequency of hypoglycemia and hypoglycemia unawareness
Other health issues

After taking all of these factors into consideration, your doctor will be able to determine what blood glucose targets are best for you. For example, if you are considered to be a healthy, younger individual with diabetes, your blood sugar targets will likely be set to reflect tighter or more rigid blood sugar control. Elderly people with type 2 diabetes may not need to have blood sugar targets so strict because they are at increased risk of having low blood sugars or because they have other health related issues. Women with gestational diabetes have blood sugar targets that are lower than non pregnant people with diabetes to protect the unborn fetus and children with type 1 diabetes have blood sugar targets that are less stringent, especially if they experience episodes of hypoglycemia unawareness.

The table below compares the general recommendations of the two sets of guidelines for both blood glucose pre and post meals as well as hemoglobin A1C (three month average of blood sugar).

Plasma blood glucose and A1C goals from the ADA and ACE for most non pregnant adults

Values	ADA	ACE
A1C	less than or equal to 7%	less than or equal to 6.5%
Before Meals	80-130mg/dL	less than 110mg/dL
1-2 Hours After Meals	less than 180mg/dL	less than 140mg/dL

Other Blood Sugar Targets

The following charts are recommended blood sugar targets determined by the ADA for children, someone with gestational diabetes, as well as the elderly.

**Plasma blood glucose and A1C goals across all pediatric-age groups**
Before meals: 90-130mg/dL	Bedtime/Overnight: 90-150mg/dL:	A1C:<7.5% (a lower goal of <7% can be achieved without excessive hypoglycemia)

**Plasma blood glucose goals for gestational diabetes**
Before meals: less than or equal to 95mg/dL	1 hour post meal: less than or equal to 140mg/dL	2 hours post meal: less than or equal to 120mg/dL A1C: 6-6.5% without hypoglycemia (this is very individualized)

**Plasma blood glucose and A1c goals for gestational diabetes who have had preexisting type 1 or type 2 diabetes**
Before meals, bedtime, overnight: 60-99mg/dL	Peak aftermeal: 100-129mg/dL	A1c: <6.0%

**Plasma blood glucose and A1c goals for elderly**
Patient characteristics/health status: Longer life expectancy, few coexisting, chronic illnesses, intact cognitive and functional status	A1c: less than 7.5%	Fasting or Premeal: 90-130mg/dL	Bedtime: 90-150mg/dL
Patient characteristics/health status: Intermediate remaining life expectancy, hypoglycemia vulnerability, fall risk, complex or intermediate illnesses, mild to moderage cognitive impairment	A1c: less than 8%	Fasting or Premeal: 90-150mg/dL	Bedtime: 100-180mg/dL
Patient characteristics/health status: Limited remaining life expectancy, very complex/poor health, long-term care or endstage chronic illnesses, moderate to severe cognitive impairment	A1c: less than 8.5%	Fasting or Premeal: 100-180mg/dL	Bedtime: 110-200mg/dL

A Good Way to Determine Your Blood Sugar Levels is Self Blood Glucose Monitoring (SBGM)?

Checking your blood glucose levels throughout the day will help you to figure out how to keep your blood sugar in good control. Your numbers can help you pattern manage and learn how to identify how food, exercise, stress, and illness, to name a few, affects your blood sugar control. First thing in the morning (when you are fasting for at least 8 hours) before breakfast, two hours after a meal and before bed are good times to test. Other recommended times include before, during, and after an exercise session, especially if it is strenuous or if you are feeling like your blood sugar may be low or high.

Your certified diabetes educator or health care provider will help you develop a routine that makes sense for you. Typically, people who take insulin or are on other glucose lowering oral medicines that can cause hypoglycemia (low blood sugar), or those with poor glucose control, should test their blood sugar more often.

Another Measurement of Blood Sugar-What is the A1C?

The hemoglobin A1C test is a a blood test that helps you and your doctor monitor your overall glucose control. It gives an average of the amount of glucose in your blood over a few months' time. It is typically ordered 2 to 4 times a year. If you are newly diagnosed or having trouble maintaining good day-to-day control, it may be ordered more often. The ADA Standards of Care suggests:

A reasonable A1C goal for many non-pregnant adults is: <7%
More stringent A1C goals (patients on no medicine or oral medicine only, who have a long life expectancy, or no significant cardiovascular disease) is: <6.5%
Less aggressive glucose control for patients who has a history of hyperglycemia, limited life expectancy, advanced micro or macrovascular disease) is: <8%

American Association of Clinical Endocrinologists and the American College of Endocrinology. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorith-2017 Executive Summary.