by Jessica Pyhtila, PharmD, BCPS, BCGP
If you have diabetes, controlling your blood sugar and A1c is likely one of your biggest health goals. Many people with diabetes are under the impression that there is only one target range for your blood sugar. However, this is a misconception.
Based on your medical history, your doctor may advise that you target a different blood sugar and A1c than someone else. Understanding why, and when you may have a customized blood sugar goal in diabetes is important as you live your life with this chronic disease.
Checking Your Blood Sugar Goals
Your doctor likely tracks your blood sugar in one of three different ways. Keeping a close eye on your blood sugar is the first step in making sure that your blood sugar is at target. For this reason, it is important to adhere to your doctor’s recommendations when it comes to these tests, which include:
- Self-monitored blood glucose (SMBG): This is the most common way that people with diabetes keep track of their blood sugar. This test is performed at home with finger-sticks and handheld blood sugar meters. Depending on your most recent blood sugars and medication regimen, your doctor may recommend you check your blood sugar anywhere from a few times a week to a few times a day. SMBG gives a snapshot of your diabetes control at a single moment in time.
- Continuous blood glucose monitoring (CGM): Some people with diabetes have a device implanted in their skin that keeps track of their blood sugar. These include the Freestyle Libre and the Dexcom systems. These systems can often give your doctor a computerized readout of your blood sugars. Like SMBG, CGM sugar gives a snapshot of your diabetes control at a single moment in time.
- Lab blood tests: At least twice a year, your doctor should have your overall blood sugar control checked with a lab test. If your blood sugar has been out of range, they may order this test up to 4 times per year. The most common of these tests is your hemoglobin A1c, which gives a long-term view of your blood sugar over the previous 3 months. An alternative test is the fructosamine test, which can show your average blood sugar over the past couple of weeks.
Common A1c and Blood Sugar Goals
There are many categories of blood sugar goals for diabetes. This includes A1c goals, as well as SMBG goals. SMBG goals are divided into before-meal (fasting) and after-meal (postprandial). After-meal readings should be checked between 1 and 2 hours after a meal, reflecting the peak blood sugar after a meal.
| Person with diabetes | A1c goal | Before-meal SMBG goal | After-meal or bedtime SMBG goal |
| Most healthy children | Less than 7%, or less than 6.5% if it can be achieved without a risk of low blood sugar | N/A | N/A |
| Children who cannot check their blood sugar regularly or who cannot reliably manage low blood sugar | Less than 7.5% | N/A | N/A |
| Children with a history of severe low blood sugar or serious medical problems | Less than 8% | N/A | N/A |
| Most healthy adults | Less than 7% | Between 80 and 130 mg/dL | Under 180 mg/dL |
| Most pregnant women | Less than 6%, or less than 7% if there is a risk of low blood sugar | Between 70 and 95 mg/dL | Between 110 and 140 mg/dL one hour after a meal Between 100 and 120 mg/dL two hours after a meal |
| Healthy older adults | Between 7 and 7.5% | Between 80 and 130 mg/dL | Between 80 and 180 mg/dL |
| Older adults with medical problems, including multiple chronic illnesses, some problems living independently, or some cognitive impairment | Under 8% | Between 90 and 150 mg/dL | Between 100 and 180 mg/dL |
| Older adults in very poor health, including serious chronic diseases, severe problems living independently, or severe cognitive impairment | No A1c goal, the focus should be on avoiding low blood sugar and blood sugar so high that it causes symptoms like excess thirst or peeing | Between 100 and 180 mg/dL | Between 110 and 200 mg/dL |
Factors Influencing Blood Sugar Goals
Your doctor will take many factors into consideration when it comes to setting your specific blood sugar and A1c goals. These factors may make your doctor decide it is safer for you to have a higher target blood sugar and A1c.They include:
- Risk of low blood sugar: Hypoglycemia (low blood sugar) can be dangerous. Your doctor may avoid medications linked to hypoglycemia — like short-acting insulin – if he or she is concerned that you are at too high of a risk of low blood sugar.
- Time since your diabetes diagnosis: If you have been recently diagnosed with diabetes, your doctor may have stricter blood sugar goals for you, to alter the course of the disease. If you have long standing diabetes, your doctor may conversely make your blood sugar goals more liberal.
- Life expectancy: Much of the health damage from diabetes takes place over the long term. For this reason, a person with a short life expectancy often will have a higher target blood sugar range than a person with a long life expectancy.
- Other medical conditions: It can be tricky to balance diabetes control with other serious chronic health conditions. As a result, your doctor may choose more liberal blood sugar goals to avoid worsening your other medical conditions.
- Cardiovascular disease (ASCVD): Diabetes is strongly linked to ASCVD. For this reason, those at highest risk of ASCVD may have tighter blood sugar goals. This includes those who have already had ASCVD complications, like a heart attack, stroke, or peripheral arterial disease.
- Your support system: Managing your blood sugar may not be entirely up to you, especially if you rely on others to help manage your diabetes. If you do not have a readily available support system to help check and manage your blood sugar, your doctor may recommend a higher goal blood sugar range.
- Your personal preference: Although your doctor can coach and guide you through your health care choices, at the end of the day you are in charge of your own health care. For this reason, if you have a personal preference for a higher or lower blood sugar goal, your doctor will take this into account when helping you develop a plan. Of course, as a trained healthcare professional, your doctor should fully educate you about the risks and benefits of your choices.
References:
American Diabetes Association. “Glycemic Targets: Standards of Medical Care in Diabetes—2021.” Diabetes Care 2021 Jan; 44(Supplement 1): S73-S84. Retrieved from https://care.diabetesjournals.org/content/44/Supplement_1/S73
American Diabetes Association. “Older Adults: Standards of Medical Care in Diabetes—2021.” Diabetes Care 2021 Jan; 44(Supplement 1): S168-S179. Retrieved from https://care.diabetesjournals.org/content/44/Supplement_1/S168
American Diabetes Association. “Children and Adolescents: Standards of Medical Care in Diabetes—2021.” Diabetes Care 2021 Jan; 44(Supplement 1): S180-S199. Retrieved from https://care.diabetesjournals.org/content/44/Supplement_1/S180
American Diabetes Association. “Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2021.” Diabetes Care 2021 Jan; 44(Supplement 1): S200-S210. Retrieved from https://care.diabetesjournals.org/content/44/Supplement_1/S200
