Managing blood sugar levels (glucose) is important for those living with diabetes—but are we doing more harm than good? Researchers are now saying that the current A1c range of staying below 5.7% might be too low for older adults (over the age of 65). Managing blood sugar in older adults should take into account their overall health and risk factors, not just numbers on a lab report.

A1c tests measure average blood glucose over a three-month period. While tight control may have been critical earlier in life, “it was really important when you were 50,” said Dr. Sei Lee, a geriatrician at the University of California, San Francisco, “now it is less important.” The reason? Over-controlling blood sugar in older adults can put them at risk for hypoglycemia (low blood sugar).

Residents with diabetes are especially vulnerable. They are more likely to have other health issues, which increases the chance of experiencing low blood sugar. Hypoglycemia can be dangerous—causing falls, stroke, cognitive decline—and it can be fatal. According to the National Institutes of Health, half of Americans with Type 2 diabetes and four in five with Type 1 who take insulin reported at least one low blood sugar episode in just a four-week period.

In response, the American Geriatrics Society now recommends that older adults aim for an A1c of 7.5% to 8%. Isn’t it time to relax the finger sticks and liberalize diets, so that your 90-something-year-old residents can enjoy more quality in their lives? Consider bringing this up with your medical director, attending providers, and pharmacist during your next QAPI committee meeting. Share this recent guidance, talk through resident-specific options, and start paving the way for a more personalized, compassionate approach to diabetes care.

Stay well and stay informed!