Blood sugar (glucose) targets for those over 65 are less strict than those for younger people. The diabetes management plan may also be different.
This article looks at the challenges of managing diabetes after 65, blood sugar targets, how to monitor your glucose, and the benefits of dietary changes and medication.
Blood Sugar and Diabetes Risk
Low blood sugar is called hypoglycemia. It is defined as a blood glucose level lower than 70 mg/dL (milligrams per deciliter). It can help diagnose diabetes or prediabetes (where sugar levels are high but not high enough to be diagnosed as type 2 diabetes).
Blood tests can measure glucose levels either while your stomach is empty (fasting values) or after eating (post-prandial values). The tests cannot diagnose diabetes on their own, but they can provide the evidence needed to warrant further testing if diabetes is suspected.
Hypoglycemia can also result from taking too much diabetes medication. Overtreatment is common in older adults.
Target Blood Sugar Levels in Older Adults
When you’re over 65, you have different diabetic treatment goals than younger people. Having other health conditions and/or cognitive impairment affects your blood sugar targets.
If you’re in good health, you may be able to manage diabetes as if you were younger. If you have other health problems, less strict management can help you avoid hypoglycemia.
First, you prick a fingertip with a small needle called a lancet. Then you place a drop of blood on a test strip in the glucometer. After a few seconds, you’ll get a number.
Generally, blood sugar should be checked before meals and at bedtime. Your healthcare provider may want you to check more or less often.
The following chart outlines what blood sugar levels should be for older adults (age 50 and over) in the hours following a meal as well as when levels are either too high or too low.
In these situations, your healthcare provider may:
Prescribe a lower dose of medicationInvolve your caregivers in monitoringCarefully watch you for low blood sugar
Nutritional Therapies
Diet is also important for managing diabetes. Maintaining a healthy diet can be a challenge for some older people. That’s because common gastrointestinal (digestive) issues can put you at risk for poor nutrition.
These issues can include:
Swallowing disorders (dysphagia) Anorexia Indigestion and bowel issues Feeling full after eating very little
Keeping a food log can help you and your care team see what nutritional problems you may have.
Medical Nutritional Therapy
Older adults may need to add medical nutrition therapy to their diabetes treatment plan. That’s when a registered dietitian creates a nutrition plan tailored to your needs.
Some strategies may include:
Adding supplements, protein, or liquid calorie boosters to maintain weightLoosening food restrictionsAssistance with food prep, eating, grocery shopping, or watching your nutrition
Medication Options
The medication you take to help control blood sugars may interact negatively with other drugs or supplements you take.
Healthcare providers have to balance effectiveness with the risk of hypoglycemia and drug interactions. They have a lot of medications to choose from.
DPP4 Inhibitors
DPP4 inhibitors lower your risk of hypoglycemia. Heart failure is a possible side effect of some drugs in this class. You’ll need a lower dose if you have poor kidney function.
Medications in this class include:
SitagliptinSaxagliptinLinagliptinAlogliptin
SGLT2 Inhibitors
SGLT2 inhibitors also reduce hypoglycemia risk. Some drugs in this class may be a good option if you have heart disease. Side effects can include:
Kidney impairmentBone lossLow blood pressure
Some SGLT2 inhibitors are:
DapagliflozinCanagliflozinEmpagliflozin
GLP1 Agonists
GLP1 agonists are given by injection, either daily or weekly. Examples of these drugs are:
ExenatideExenatide ER LiraglutideAlbiglutideLixisenatideDulaglutideSemaglutide
Exenatide ER and albiglutide preparation can be time-consuming. Possible side effects are:
Nausea Diarrhea Weight loss Pancreatitis Appetite loss
Digestive side effects like decreased appetite can lead to a dangerous amount of weight loss in older people.
Dual-Acting GLP-1 and GIP Receptor Agonists
In May 2022, the Food and Drug Administration (FDA) approved the once-weekly injection, Mounjaro (tirzepatide). Mounjaro is the only dual-acting GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) receptor agonist approved to improve glycemic control in adults with type 2 diabetes in addition to diet and exercise.
Mounjaro may cause thyroid cancer. Do not use Mounjaro if you or any of your family members have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Summary
Hypoglycemia becomes more likely when you’re over 65. Blood sugar goals are looser to help curb that risk. Frequent blood sugar checks can help prevent it, too.
Diabetes is managed through diet and medications. Managing your diet can get harder with age and failing health. Your healthcare provider may suggest medical nutrition therapy.
Many drugs can help manage diabetes. Your provider can choose the one that’s safest for you based on your individual needs and health status.
A Word From Verywell
It’s normal for your diabetes management to change with age. Follow the treatment plan laid out for you by your healthcare provider(s). Remember that your target numbers may be higher than those for other age groups.
If you need help managing your diabetes, speak up. Your care team is there to guide you and help you find the resources you need.
Shakiness, nervousness, or anxietySweating and chillsIrritabilityConfusionRapid heartbeatDizzinessFatigue and weaknessBlurred visionHeadachesClumsinessSeizures
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