What is the target premeal glucose level for patients on insulin (insulin therapy)?

Target Premeal Glucose Levels for Patients on Insulin Therapy

For most non-pregnant adults with diabetes on insulin therapy, the recommended premeal capillary plasma glucose target is 80-130 mg/dL (4.4-7.2 mmol/L). 1

Target Glucose Levels by Patient Population

Non-Pregnant Adults with Diabetes

• Premeal (preprandial) target: 80-130 mg/dL (4.4-7.2 mmol/L) 1
• Peak postprandial target: <180 mg/dL (<10.0 mmol/L) 1, 2
• Postprandial measurements should be taken 1-2 hours after beginning a meal 1, 2

Hospitalized Patients

• Non-critically ill patients: Premeal glucose target <140 mg/dL (7.8 mmol/L) with random glucose <180 mg/dL (10.0 mmol/L) 1
• Critically ill patients: Target glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) when on intravenous insulin 1
• Consider reassessing insulin regimen if glucose falls below 100 mg/dL (5.6 mmol/L) 1
• Modify regimen when glucose values are <70 mg/dL (3.9 mmol/L) unless explained by other factors 1

Pregnant Women with Diabetes

• Women with gestational diabetes: Preprandial target ≤95 mg/dL (5.3 mmol/L) 1
• Women with preexisting type 1 or type 2 diabetes who become pregnant: Premeal target 60-99 mg/dL (3.3-5.4 mmol/L) 1

Individualizing Glycemic Targets

Glycemic targets may need adjustment based on:

• Duration of diabetes 1
• Age and life expectancy 1
• Comorbid conditions 1
• Known cardiovascular disease or advanced microvascular complications 1
• Hypoglycemia unawareness 1
• History of severe hypoglycemia 1

Hypoglycemia Prevention and Management

• Define hypoglycemia as any blood glucose <70 mg/dL (3.9 mmol/L) 1
• Early recognition and treatment of mild to moderate hypoglycemia (40-69 mg/dL) can prevent progression to severe episodes 1
• Treat hypoglycemia with fast-acting carbohydrates when glucose is ≤70 mg/dL (3.9 mmol/L) 1, 2
• Consider raising glycemic targets for patients with hypoglycemia unawareness or history of severe hypoglycemia 1

Insulin Regimen Considerations

• For type 1 diabetes, recommended therapy includes multiple-dose insulin injections (3-4 injections/day of basal and prandial insulin) or continuous subcutaneous insulin infusion 1
• Match prandial insulin to carbohydrate intake, premeal blood glucose, and anticipated activity 1, 2
• For hospitalized patients, a basal plus correction insulin regimen is preferred for those with poor oral intake; a regimen with basal, nutritional, and correction components is preferred for those with good nutritional intake 1, 3
• Sliding scale insulin as the sole method of insulin treatment is strongly discouraged 1, 3, 4

Monitoring Effectiveness

• Target postprandial glucose specifically when premeal glucose values are within target but A1C remains above target 2
• Consider continuous glucose monitoring to better identify glucose patterns and guide therapy 2
• Evaluate A1C regularly as it remains the primary predictor of complications 2

Common Pitfalls and Caveats

• Overly strict glycemic targets (<110 mg/dL or 6.1 mmol/L) are not recommended as they increase risk of hypoglycemia without improving outcomes 1, 5
• The American Diabetes Association changed its preprandial target from 70-130 mg/dL to 80-130 mg/dL in 2015 to limit overtreatment and provide a safety margin when titrating glucose-lowering medications 1
• Carbohydrate-to-insulin ratios may have diurnal variance, requiring different calculations for breakfast versus lunch and dinner 6
• When transitioning from intravenous to subcutaneous insulin in hospitalized patients, precautions should be taken to prevent hyperglycemia 1