From the Guidelines
The pre-breakfast blood glucose target for most adults with Diabetes Mellitus (DM) should be between 70-130 mg/dl (3.9-7.2 mmol/l). To achieve this:
- Check blood glucose first thing in the morning, before eating or drinking anything except water.
- Use a reliable glucose meter and test strips.
- Aim to test at approximately the same time each day for consistency. If your levels are consistently outside this range:
- For high readings: Consider adjusting evening medications or meal timing with your doctor's guidance.
- For low readings: You may need to adjust nighttime insulin or medications that can cause hypoglycemia. This target range is based on the standards of medical care in diabetes, as outlined in the 2011 guidelines 1. Key considerations for individualized targets include:
- Duration of diabetes
- Age/life expectancy
- Comorbid conditions
- Known cardiovascular disease (CVD) or advanced microvascular complications
- Hypoglycemia unawareness
- Individual patient considerations It is essential to note that postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals, with a target of less than 180 mg/dl (10.0 mmol/l) 1-2 hours after the beginning of the meal, as recommended by the same guidelines 1.
From the FDA Drug Label
Patients or study personnel used an algorithm to adjust the Insulin Glargine and NPH insulin dosages to a target fasting plasma glucose ≤100 mg/dL The target for pre-breakfast blood glucose in Diabetes Mellitus (DM) is ≤100 mg/dL 2.
From the Research
Pre-Breakfast Blood Glucose Targets
- The American Diabetes Association suggests a fasting blood glucose goal of 80 to 130 mg per dL 3.
- A study published in the Journal of the Medical Association of Thailand found that achieving a fasting plasma glucose target may not reflect hemoglobin A1c target achievement, and recommends frequent monitoring of pre- and post-meal blood glucose levels to assess overall glycemic control 4.
- The American Diabetes Association does not provide a specific pre-breakfast blood glucose target, but recommends a fasting blood glucose goal of 80 to 130 mg per dL 3.
- A study published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy found that a difference between bedtime and pre-breakfast plasma glucose levels indicates the need for prandial insulin in basal insulin-treated type 2 diabetic patients with normal fasting glucose 5.
Blood Glucose Monitoring
- A study published in the Journal of the Medical Association of Thailand found that elevated blood glucose at all times was the commonest finding in type 2 diabetic patients whose fasting plasma glucose was less than 130 mg/dl but hemoglobin A1c level was greater than 7% 4.
- A study published in Nihon Ronen Igakkai Zasshi found that before breakfast plasma glucose values are more predictive of low blood glucose values in the night during sleep than after-breakfast blood glucose values, but do not predict low blood glucose values before supper in patients on oral hypoglycemic agents 6.
Glycemic Control
- A study published in Current Opinion in Endocrinology, Diabetes, and Obesity found that hospital hyperglycemia is associated with increased morbidity and mortality, as well as increased length of stay and costs, and recommends a blood glucose target for critically ill patients of 140-180 mg/dl 7.
- A study published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy found that supplementation of basal-supported oral therapy with a single daily injection of prandial insulin is safe and effective for reducing hemoglobin A1c and postprandial glucose levels in patients with a high difference between bedtime and pre-breakfast plasma glucose levels 5.