As we get older, managing diabetes can become more complex. Health conditions, medications, changes in eating habits and physical activity, and the risk of low blood sugar can all affect diabetes management.
So, what blood glucose levels should older adults with type 2 diabetes aim for? The answer is not necessarily the same for everyone. While many older adults can use the same targets as other adults with diabetes, targets may need to be adjusted for people who are frail, functionally dependent, have dementia, experience frequent hypoglycemia or have a limited life expectancy.
Article highlights
- Find out when standard blood glucose targets may still apply as you get older.
- Learn why your overall health may matter more than your age when setting targets.
- See how frailty and hypoglycemia risk can change your A1C and blood glucose goals.
- Discover why “lower” blood sugar is not always better for older adults.
- Learn what to discuss with your healthcare team about your personal targets.
What are the usual blood glucose and A1C targets for older adults?
For most adults with diabetes, including many older adults who are otherwise healthy and functionally independent, the usual targets are:
- A1C: 7.0% or lower
- Before meals (fasting): 4.0–7.0 mmol/L
- Two hours after the start of eating: 5.0–10.0 mmol/L
These are general targets. Your healthcare provider may recommend different targets based on your health, medications and risk of hypoglycemia.
Does everyone over age 65 need a different blood glucose target?
No. Age alone does not determine your blood glucose target.
An otherwise healthy, independent older adult may have targets similar to those recommended for younger adults. However, targets may be adjusted when an older person has significant frailty, functional limitations, dementia, recurrent severe hypoglycemia or other health concerns.
This is why your healthcare team may consider your overall health and ability to manage your diabetes safely, rather than simply your age.
What blood glucose targets may be appropriate for frail older adults?
For older adults who are frail or have significant functional limitations, a less aggressive approach to blood glucose control may be appropriate.
The 2025 Diabetes Canada quick reference guide lists an A1C target of ≤ 8.5% for frail older adults and/or those with dementia, depending on individual circumstances. For people who are functionally dependent, the target may also be less stringent (≤8.0%) than the usual ≤7.0% target.
Blood glucose targets may also be higher for these individuals. The goal is to balance the benefits of glucose control with the potential harms of treatment—particularly hypoglycemia.
Why can lower blood sugar targets be risky for some older adults?
It may seem that lower blood sugar is always better, but this is not necessarily true. Older adults who are frail or have multiple health conditions may be more vulnerable to low blood sugar (hypoglycemia). Some diabetes medications, particularly insulin and insulin secretagogues such as sulfonylureas, can increase this risk.
Severe hypoglycemia can cause confusion, falls, loss of consciousness and other serious problems. For some older adults, avoiding hypoglycemia may therefore be a more important priority than achieving a very low A1C.
How does frailty affect diabetes management?
Frailty is more than simply being older. It refers to a reduced ability to cope with physical or health-related stress.
Signs that may indicate frailty include:
- Unintentional weight loss
- Weakness
- Persistent fatigue or exhaustion
- Slow walking speed
- Low levels of physical activity
How should diabetes targets be individualized for an older adult?
Your healthcare team may consider several factors, including:
- Your level of independence and physical function
- Other health conditions
- Your risk of hypoglycemia
- Your diabetes medications
- Your ability to manage medications and monitor blood glucose
- Your cognitive health
- Your life expectancy and personal goals
What should older adults do if they are unsure about their blood glucose targets?
Ask your healthcare team to review your personal targets. Do not assume that the target you were given years ago is still the right one.
It can be particularly important to have your targets reviewed if you have experienced low blood sugar, started or stopped diabetes medication, become less active, lost weight unintentionally, developed other health problems or had difficulty managing your diabetes.
Your blood glucose target should help you manage your diabetes safely, while supporting your overall health and quality of life.
3-Step Action Plan: Set Safer Blood Glucose Targets as You Age
- Know your numbers: Ask for your current A1C and blood glucose targets.
- Review your risks: Discuss hypoglycemia, medications and overall health.
- Revisit your goals: Review your targets whenever your health or treatment changes.
Diabetes management should be individualized. Talk with your healthcare provider before making changes to your blood glucose targets or diabetes medications.
