What are the recommended fasting, pre‑meal, post‑prandial glucose ranges and HbA1c targets for adults with diabetes, and how should these targets be adjusted for older patients or those with comorbidities?

Blood Sugar Targets for Adults with Diabetes

For most adults with diabetes, aim for an A1C below 7%, fasting/pre-meal blood sugars between 80-130 mg/dL, and blood sugars below 180 mg/dL two hours after meals. 1

Standard Blood Sugar Ranges

Daily Blood Sugar Goals

• Fasting and before meals: 80-130 mg/dL (4.4-7.2 mmol/L) 1, 2
• 2 hours after starting a meal: Less than 180 mg/dL (10.0 mmol/L) 1, 2
• A1C (3-month average): Less than 7.0% (53 mmol/mol) 1, 2

The pre-meal target was specifically raised from 70-130 mg/dL to 80-130 mg/dL to provide a safety margin against low blood sugar while maintaining good overall control. 1, 3

When to Check Blood Sugar

• Before breakfast (fasting) 1
• Before lunch and dinner 1
• 1-2 hours after starting each meal to check post-meal peaks 1
• At bedtime if taking insulin or certain medications 4

Adjusting Targets Based on Your Situation

You May Need TIGHTER Control (A1C closer to 6.5%) If You:

• Were recently diagnosed with diabetes 1, 3
• Are younger with many years ahead 1, 3
• Have no heart disease or other major health problems 1, 3
• Have never had severe low blood sugar episodes 1, 3
• Are highly motivated and managing diabetes well 1, 3

You Need LOOSER Control (A1C 7.5-8.0%) If You:

• Have had diabetes for many years 1, 3
• Are older (especially over 65) with limited life expectancy 1, 3
• Have serious heart disease, kidney disease, or other major health problems 1, 3
• Have had severe low blood sugar reactions or don't feel symptoms when blood sugar drops 1, 3
• Have difficulty managing complex medication regimens 1, 3
• Live alone with limited support 1, 3

For healthy older adults: Target A1C 7.0-7.5% with at least 70% of readings between 70-180 mg/dL and less than 4% of time below 70 mg/dL. 1

For frail older adults with multiple health problems: Target A1C below 8.0% with at least 50% of readings between 70-180 mg/dL and less than 1% of time below 70 mg/dL. 1

Critical Safety Information

Preventing Low Blood Sugar (Hypoglycemia)

Low blood sugar is defined as any reading below 70 mg/dL (3.9 mmol/L). 1

• If you've had severe low blood sugar episodes, your targets must be raised immediately to prevent future dangerous episodes. 1, 3
• Treat any blood sugar below 70 mg/dL with 15-20 grams of fast-acting carbohydrate (glucose tablets, juice, regular soda). 1
• Recheck in 15 minutes—if still below 70 mg/dL, repeat treatment. 1
• Once normal, eat a meal or snack to prevent another drop. 1

When Low Blood Sugar Takes Priority Over A1C Goals

If you experience any of the following, your doctor should raise your blood sugar targets even if your A1C is above goal: 1, 3

• You don't feel symptoms when blood sugar drops (hypoglycemia unawareness)
• You've had a severe low requiring help from another person
• You have repeated lows below 54 mg/dL (3.0 mmol/L)
• You have unexplained low blood sugars

Why Both Fasting and After-Meal Sugars Matter

When your A1C is near 7%, after-meal blood sugars contribute about 70-80% to your overall control. 5, 6 This means controlling spikes after eating becomes increasingly important as you get closer to goal. 5

When your A1C is above 9%, fasting blood sugar becomes more important (contributing 60-70% to overall control), so focus shifts to overnight and morning control first. 6

Research shows that 94% of people who keep after-meal sugars below 140 mg/dL achieve an A1C below 7%, while only 64% who just control fasting sugars reach that goal. 5 This emphasizes checking blood sugar 1-2 hours after meals, not just in the morning. 1, 5

Common Mistakes to Avoid

• Don't ignore after-meal blood sugars if your A1C isn't at goal despite good fasting numbers—you need to check 1-2 hours after eating. 1, 5
• Don't push for very tight control (A1C below 6.5%) if you're older, have had diabetes for many years, or have heart disease—the risks outweigh benefits. 3
• Don't keep the same targets year after year—as you age or develop other health problems, your targets should be adjusted. 1, 3
• Never prioritize A1C goals over preventing low blood sugar—severe lows can be immediately dangerous. 1, 3

How Often to Check A1C

• Every 3 months if your treatment changed or you're not meeting goals 3
• Every 6 months if you're stable and meeting goals 3