Blood Glucose Management in Assisted Living Facilities

Target Blood Glucose Ranges

The American Diabetes Association recommends pre-meal glucose targets of <140 mg/dL (7.8 mmol/L) for most assisted living residents 4, 5, 6
The American Diabetes Association recommends random/post-meal glucose targets of <180 mg/dL (10.0 mmol/L) for most assisted living residents 4, 5, 6
The American Diabetes Association recommends an acceptable range of 100-180 mg/dL for most residents 1, 2, 7

The American Diabetes Association recommends immediate provider notification for blood glucose ≤70 mg/dL (3.9 mmol/L) 1, 2, 3
The American Diabetes Association recommends urgent provider notification for glucose 70-100 mg/dL (3.9-5.6 mmol/L) 1, 2, 3
The American Diabetes Association recommends urgent provider notification for glucose >250 mg/dL (13.9 mmol/L) within a 24-hour period 1, 2, 3
The American Diabetes Association recommends urgent provider notification for glucose >300 mg/dL (16.7 mmol/L) over 2 consecutive days 1, 2, 3

The American Diabetes Association prioritizes hypoglycemia prevention because residents in assisted living have multiple risk factors including impaired cognitive and renal function, slowed hormonal counterregulation, suboptimal hydration, variable appetite and nutritional intake, polypharmacy, and slowed intestinal absorption 1, 2, 7
The American Diabetes Association recommends individualization of care based on the resident's functional status, life expectancy, presence of diabetes complications, and ability to recognize and communicate hypoglycemic symptoms 1, 2, 7
The Lancet Diabetes and Endocrinology suggests that more relaxed targets may be appropriate (up to 200 mg/dL or 11.1 mmol/L) for residents with severe comorbidities, limited life expectancy, or when frequent glucose monitoring is not feasible 6

The American Diabetes Association recommends that assisted living staff receive diabetes education covering recognition of hypoglycemia symptoms, proper glucose monitoring technique, when to contact providers, and basic diabetes management principles 1, 2
The American Diabetes Association recommends that facilities develop written policies for prevention and management of both hypoglycemia and hyperglycemia specific to their setting 1, 2

The Lancet Diabetes and Endocrinology advises against pursuing overly aggressive glucose targets (<110 mg/dL or 6.1 mmol/L) as these increase hypoglycemia risk without improving outcomes in this population 6
The American Diabetes Association recommends avoiding rigid therapeutic diets that may decrease food intake and contribute to unintentional weight loss and undernutrition, which are common in assisted living residents 1, 2, 3
The American Diabetes Association advises against using sliding scale insulin alone as the primary management strategy; scheduled basal insulin or oral agents are preferred to prevent both hyper- and hypoglycemia 1, 7