As you age, your risk for higher blood sugar increases—which raises the risk of type 2 diabetes for adults in their 50s, 60s, and 70s. Using a chart of blood sugar levels by age can help you track glucose.
Blood sugar (glucose) targets for older people with diabetes tend to be different than for younger people. Estimating the normal blood glucose levels for your age and health needs, you and your healthcare provider can set up a targeted management plan.
Blood Sugar Levels and Older Adults
Both high and low blood sugar are concerns for older adults.
Because your risk for high blood sugar goes up as you get older, it's essential to track your levels and monitor your risk of diabetes. According to some research, the average age for a type 2 diabetes diagnosis is 47.9 years. In addition, nearly 27% of people with the disease are over age 65.
Low blood sugar is also a concern. Researchers say hypoglycemia (low blood sugar) is likely underreported in adults over 65. However, if your blood sugar is too low, driving or other situations could be dangerous because you could suddenly develop symptoms such as dizziness.
Cognitive decline and chronic illnesses can make it hard for some older adults to follow a diabetes care plan or report symptoms to a doctor or caregivers. That can happen even if someone has successfully managed their blood sugar for years.
In these situations, your healthcare provider may:
- Prescribe a lower dose of medication
- Consider automated insulin delivery (like an insulin pump) if appropriate
- Recommend continuous glucose monitoring (CGM)
- Involve your caregivers in monitoring
Monitoring Blood Sugar in Older Adults
Blood sugar is commonly checked with a device called a glucometer. You may prick a fingertip with a small needle called a lancet. Then you place a drop of blood on atest stripin the glucometer to get a blood sugar reading.
Generally, blood sugar should be checked before meals and at bedtime. Your healthcare provider may want you to check more or less often.
Some people use CGM instead, which eliminates the need for finger sticks and can measure blood sugars in real time as often as every five minutes.
A1C Blood Tests and Diabetes
It's likely that your healthcare provider will monitor your hemoglobin A1C levels, often just called A1C or HbA1C. Your A1C level goes up with age. This blood test shows your average blood sugar over the last few months, rather than at a fixed point in time. A1C testing for diabetes is recommended as early as age 35.
Blood Sugar Levels in Older Adults
The following chart outlines normal blood sugar levels, as well as ranges that are consistent with prediabetes and diabetes. These ranges apply to all adults, including those over 65.
| Fasting blood glucose | Hemoglobin A1C | |
|---|---|---|
| Normal | 70 to 99 mg/dL | Less than 5.7% |
| Prediabetes | 100 to 125 mg/dL | 5.7 to 6.4% |
| Diabetes | 126 mg/dL or higher | 6.5% or higher |
Target Blood Sugar Levels for Older Adults
Blood sugar targets for older people with diabetes, particularly those 65 and older, are often not as strict as those for younger individuals.
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 blood glucose 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.).
| Health status | Target A1C | Fasting glucose | Bedtime glucose |
|---|---|---|---|
| Healthy or with few underlying health issues (comorbidities) | <7.5% | 80–130 mg/dL | 80–180 mg/dL |
| Multiple chronic comorbidities or two or more (IADL) | <8% | 90–150 mg/dL | 100–180 mg/dL |
| Very poor health or end-stage chronic illness | No specific target A1C | 100–180 mg/dL | 110–200 mg/dL |
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.
Symptoms of High or Low Glucose
High Blood Sugar
Blurred vision
Confusion
Excessive hunger and thirst
Fruity-smelling breath
Fatigue
Low Blood Sugar
Shaking, lack of coordination
Confusion
Excessive sweating
Fast heart rate
Slurred speech
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 certain gastrointestinal (digestive) issues and dental problems can put you at risk for poor nutrition.
These issues can include:
- Swallowing disorders (dysphagia)
- Poor dentition (such as missing teeth or tooth decay)
- 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. They include:
- Metformin: This oral medication belongs to a class of drugs called biguanides. It works by decreasing the production of glucose in the liverand increasing the body's sensitivity to insulin.
- 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) has been associated with a higher risk of thyroid cancer.
Summary
Hyperglycemia 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.
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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
Brewster is a journalist with over 20 years of writing experience specializing in science and healthcare content.
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