Tolerable Fasting Blood Sugar for Maintenance in Known Diabetes Mellitus
Standard Targets for Most Adults with Diabetes
- The American Diabetes Association recommends a fasting/preprandial glucose target of 80-130 mg/dL (4.4-7.2 mmol/L) for the majority of non-pregnant adults with diabetes, which correlates with achieving an HbA1c <7.0% (53 mmol/mol) and reduces microvascular complications 2, 3
- Peak postprandial glucose should remain <180 mg/dL (10.0 mmol/L) to complement fasting control 2
Age-Stratified and Health Status-Based Targets
- For healthy older adults with few comorbidities and intact function, the recommended fasting glucose target is 80-130 mg/dL (4.4-7.2 mmol/L) 1
- For complex/intermediate health older adults with multiple comorbidities or mild-moderate cognitive impairment, the recommended fasting glucose target is 90-150 mg/dL (5.0-8.3 mmol/L) 1
- For very complex/poor health older adults with end-stage illness, severe cognitive impairment, or ADL dependence, the recommended fasting glucose target is 100-180 mg/dL (5.6-10.0 mmol/L) 1
More Stringent Targets (When Appropriate)
- The American Diabetes Association recommends a fasting glucose target of 110-140 mg/dL (6.1-7.8 mmol/L) for selected patients with short diabetes duration, long life expectancy, no significant cardiovascular disease, and no history of severe hypoglycemia 3, 4, 1
Hospitalized Patients
- The recommended target range for hospitalized patients is 140-180 mg/dL (7.8-10.0 mmol/L) for both critically ill and non-critically ill patients 4
- Insulin therapy should be initiated when glucose persistently exceeds 180 mg/dL (10.0 mmol/L) 4
Critical Hypoglycemia Thresholds to Avoid
- Glucose <70 mg/dL (3.9 mmol/L) requires immediate treatment with 15-20g of fast-acting carbohydrate 2
- Glucose <54 mg/dL (3.0 mmol/L) represents clinically significant hypoglycemia with neuroglycopenic symptoms requiring urgent intervention 2