When it comes to managing A1C levels, how low is too low for our older patients? Hypoglycemia is a potentially serious risk for older adults with diabetes, so it’s important to know the recommended levels for these individuals.

The American Diabetes Association’s A1C recommendations are tailored according to age and other factors.

American Diabetes Association. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(suppl 1):S128–S145.

 

Older adults with diabetes may not know of these different recommendations, and the consequences of low blood glucose can be serious.

 

While mild hypoglycemia is treatable, more serious instances come with grave consequences. “Severely low blood glucose can cause serious complications, including passing out, coma, or death,” according to the National Institute of Diabetes and Digestive and Kidney Diseases.

National Institute of Diabetes and Digestive and Kidney Diseases. Low Blood Glucose (Hypoglycemia). July 2021.

 

Continue reading to learn how older diabetes patients are at risk.

 

 

Hypoglycemia is a serious concern

Hypoglycemia requires immediate treatment to get blood sugar back to the recommended range, according to the Mayo Clinic.

Mayo Clinic. Hypoglycemia. November 18, 2023.

Signs and symptoms of more severe hypoglycemia can include:

 

• Confusion, unusual behavior or both, such as the inability to complete routine tasks

• Loss of coordination

• Slurred speech

• Blurry vision or tunnel vision

• Nightmares, if asleep

 

Hypoglycemia linked to fall risk

Older adults experiencing hypoglycemia are at greater risk for falls. A 2023 study published in Diabetes Epidemiology and Management concluded that “severe hypoglycemia and falls are common, serious, life-threatening events which should be assessed when evaluating older patients with diabetes.”

Moffet HH, Huang ES, Liu JY, et al. Severe hypoglycemia and falls in older adults with diabetes: The Diabetes & Aging Study. Diabetes Epidemiology and Management. 2023;12(Oct-Dec):100162

 

 

Fall prevention is a key consideration for protecting our older patients from injuries and fractures; in addition, it can help avoid emergency room visits, and even save their life.

 

 

What to do

Diabetes care and A1C recommendations should be individualized for older adults.

A challenge of treating older adults with diabetes is that “it is a very heterogeneous population,” explains Carol M. Mangione, MD, Professor of Medicine and Public Health at UCLA, in an interview for the National Institute of Diabetes and Digestive and Kidney Diseases.

National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Care and Older Adults. YouTube. May 10, 2021.

 

The American Diabetes Association’s Standards of Care in Diabetes are updated at least yearly. For 2025, the guidelines summarize how A1C goals should be individualized according to the patient’s  health, function, and other factors.

American Diabetes Association. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(suppl 1):S128–S145.

 

 

Specifically, the Standards advise physicians to:

• Select glycemic goals that avoid symptomatic hypoglycemia and hyperglycemia in all individuals. 

• Consider individuals’ resources and support systems to safely achieve glycemic goals. 

• Incorporate the preferences and goals of people with diabetes through shared decision-making.