Blood Glucose Parameters for Assisted Living Facilities
For residents with type 2 diabetes in assisted living facilities, instruct staff to call the provider immediately for any blood glucose ≤70 mg/dL (3.9 mmol/L), and call as soon as possible for values between 70-100 mg/dL (3.9-5.6 mmol/L), values >250 mg/dL (13.9 mmol/L) within 24 hours, or values >300 mg/dL (16.7 mmol/L) over 2 consecutive days. 1
Target Blood Glucose Ranges
General targets for most assisted living residents:
- Pre-meal glucose: <140 mg/dL (7.8 mmol/L) 1
- Random/post-meal glucose: <180 mg/dL (10.0 mmol/L) 1
- Acceptable range: 100-180 mg/dL for most residents 1
These targets prioritize safety over tight control because older adults in long-term care facilities are particularly vulnerable to hypoglycemia due to impaired cognitive function, variable appetite, polypharmacy, and unpredictable meal consumption. 1
Critical Alert Parameters
Immediate Provider Notification Required:
- Blood glucose ≤70 mg/dL (3.9 mmol/L) - This represents hypoglycemia requiring urgent intervention 1
Urgent Provider Notification (Call as Soon as Possible):
- Glucose 70-100 mg/dL (3.9-5.6 mmol/L) - Medication regimen likely needs adjustment 1
- Glucose >250 mg/dL (13.9 mmol/L) within a 24-hour period 1
- Glucose >300 mg/dL (16.7 mmol/L) over 2 consecutive days 1
- Any reading too high for the glucometer to measure 1
- Patient is sick with vomiting, symptomatic hyperglycemia, or poor oral intake 1
Key Considerations for Assisted Living Settings
Hypoglycemia prevention is the priority 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
Individualization is essential based on the resident's functional status, life expectancy, presence of diabetes complications, and ability to recognize and communicate hypoglycemic symptoms. 1
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. 1
Staff Training Requirements
Assisted living staff should receive diabetes education covering recognition of hypoglycemia symptoms, proper glucose monitoring technique, when to contact providers, and basic diabetes management principles. 1
Facilities should develop written policies for prevention and management of both hypoglycemia and hyperglycemia specific to their setting. 1
Common Pitfalls to Avoid
Do not pursue overly aggressive glucose targets (<110 mg/dL or 6.1 mmol/L) as these increase hypoglycemia risk without improving outcomes in this population. 1, 2
Avoid rigid therapeutic diets that may decrease food intake and contribute to unintentional weight loss and undernutrition, which are common in assisted living residents. 1
Do not use sliding scale insulin alone as the primary management strategy; scheduled basal insulin or oral agents are preferred to prevent both hyper- and hypoglycemia. 1