What Are Blood Sugar Levels for Older Adults?

If you're over 65, you have a higher risk of developing type-2 diabetes. More than 20% of the people diagnosed with this disease are 65 or older. That's more than any other age group.

Blood sugar 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 blood sugars, and the benefits of dietary changes and medication.

Concerned nurse checks patient's blood sugar

SDI Productions / Getty Images

Managing Diabetes Over Age 65

Low blood sugar is called hypoglycemia. It's defined as a level lower than 70 mg/dL (milligrams per decilitre). Symptoms include:

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

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.

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

Diabetes Screening

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.

Blood Sugar Levels

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.

OTHER CONDITIONS COGNITIVE IMPAIRMENT TARGET HbA1C FASTING TARGET BEDTIME TARGET
None or few None or mild 7.5% or less 90–130 mg/dL 90–150 mg/dL
Multiple Mild to moderate 8% or less  90–150 mg/dL 100–180 mg/dL
Late-stage illness Moderate to severe 8%-9% 100–180 mg/dL 110–200 mg/dL

Monitoring Blood Sugar

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.

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

Recap

Diabetes is managed differently when you're over 65. Hypoglycemia is more of a risk. Blood sugars may be less strictly managed to counter that. It's important to monitor your blood sugars often.

Nutritional Therapy

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

Recap

Diet and medications are two ways to manage diabetes. Ask for help if your health is making it hard to manage your diet. Consider medical nutrition therapy.

Medication

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.

Recap

Healthcare providers have many drug options to choose from. They must weigh the pros and cons of each while considering your overall health and what other medications you're on.

Summary

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.

Was this page helpful?
9 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.

  2. American Diabetes Association. Hypoglycemia (low blood sugar).

  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. National Institutes of Health, U.S. National Library of Medicine: Medline Plus. Hypoglycemia.

  5. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Supplement 1):S17-S38. doi:10.2337/dc22-S002

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

  7. Centers for Disease Control and Prevention. Diabetes: Monitoring your blood sugar.

  8. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650-2664. doi:10.2337/dc12-1801

  9. 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