From the Guidelines
For a 69-year-old patient, a blood glucose level below 70 mg/dL (3.9 mmol/L) is generally considered low (hypoglycemia). This threshold is supported by the most recent guidelines, including the 2025 standards of care in diabetes 1. According to these guidelines, a healthcare professional should be called immediately in cases of low blood glucose levels (<70 mg/dL [<3.9 mmol/L]).
Key Considerations
- Symptoms of low blood sugar include shakiness, sweating, confusion, irritability, dizziness, and weakness.
- Severe hypoglycemia (below 54 mg/dL or 3.0 mmol/L) requires immediate treatment with 15-20 grams of fast-acting carbohydrates.
- Older adults are particularly vulnerable to hypoglycemia due to age-related changes in counter-regulatory hormone responses, decreased kidney function affecting medication clearance, and sometimes impaired awareness of hypoglycemic symptoms.
Management
- If low blood sugar episodes occur frequently, the patient should consult their healthcare provider as medication adjustments may be necessary.
- The treatment plan may need to be adjusted if glucose values are 70–100 mg/dL (3.9–5.6 mmol/L) 1.
- It is essential to prioritize the patient's safety and well-being, and treatment of hypoglycemia should not be delayed 1.
From the Research
Definition of Low Glucose Level
- A blood glucose level under 70 mg/dL (3.9 mmol/L) is defined as hypoglycaemia 2
- Symptoms of hypoglycaemia may occur at higher blood glucose levels in individuals with poor glycaemic control 2
Risk of Hypoglycaemia in Older Adults
- Older adults with diabetes are at risk of hypoglycaemia, particularly those with insulin-treated type 2 diabetes 3
- Vulnerable patients with type 2 diabetes, including those with "frailty", are at dual risk of severe hypoglycaemia and cardiovascular outcomes 2
Management of Hypoglycaemia
- A management protocol for hypoglycaemia should be designed and implemented, including a clear prevention and treatment plan 2
- Continuous glucose monitoring (CGM) should be considered for individuals with increased risk for hypoglycaemia, impaired hypoglycaemia awareness, frequent nocturnal hypoglycaemia, and history of severe hypoglycaemia 2
Glucose Level Considerations for a 69-Year-Old Patient
- While there is no specific glucose level considered "too low" for a 69-year-old patient, a level under 70 mg/dL (3.9 mmol/L) is generally considered hypoglycaemic 2
- The American Diabetes Association recommends individualized glycaemic goals, taking into account factors such as age, comorbidities, and risk of hypoglycaemia 2