Guidelines Blood Sugar Levels: Normal, Pre-diabetes, Diabetes

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Guidelines Blood Sugar Levels

Newest Guidelines Blood Sugar Levels (NOT for Diabetes in Pregnancy):

Normal Range Blood Sugar Levels
U.S. Levels to Diagnose Diabetes & Pre-diabetes
Canadian Levels to Diagnose Diabetes & Pre-diabetes
Glucose Guidelines (targets) for Diabetes

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Guidelines blood sugar levels exist because diabetes associations know that slightly elevated glucose levels could damage your health. Most people I see as a diabetes educator aren't aware that pre-diabetes glucose levels are also associated with increased eye damage, heart attacks and strokes. Check the guidelines blood sugar levels below to see if you are at risk. Learn healthy blood sugar levels with diabetes.

Normal Range Blood Sugar Levels

	Normal - US (mg/dl)	Normal - Canada (mmol/L)
Fasting Glucose	< 100 *	< 6.1*
2 hr after eating	< 140	< 7.8
A1c (glycosylated hemoglobin)	< 6% (0.060)	< 6% (0.060)
*Note that in the U.S., the value for normal fasting glucose is less than that in Canada. 100 mg/dl converts to 5.6 mmol/L.

Normal range blood sugar levels have been harder to define over the recent years. Research keeps revealing that even slight elevations in blood glucose are associated with eye damage and increased risk of heart attack and stroke even before people get diabetes.

Of course, the slightly higher glucose levels put these same people at increased risk for getting diabetes. These slight elevations are now termed as "pre-diabetes".

In Canada, if you have a fasting glucose of 5.7-6.9 mmol/L the guidelines suggest you have a 75 g oral glucose tolerance test (OGTT) to screen for diabetes. This test requires you drink a sweet liquid and have your blood glucose tested every 1/2 hour for 2 hours. A signficant number of people can have normal or near normal fasting glucose levels but test positive for diabetes when they have the 2 hr OGTT done. If you already have diabetes, you do not need this test. (I've had numerous diabetic patients over the years ask to have this test done. Once you are diagnosed with diabetes, this test is unnecessary).

You will notice in the above guidelines blood sugar levels that the fasting values do not convert equally. Canada allows for a higher acceptable fasting value than does the United States. This is because research can be interepreted differently and of course, guidelines are time sensitive. With each new release of guidelines blood sugar levels there is a change (of late, anyway). Notably, the numbers to diagnose diabetes or pre-diabetes drop.

U.S. Glucose Levels to Diagnose
Diabetes & Pre-diabetes

ADA Guidelines Blood Sugar Levels for Diagnosing Diabetes & Pre-diabetes
	Fasting Glucose (mg/dl)		2 hr after eating or 75-gram OGTT (mg/dl)
Pre-diabetes: IFG	100 – 125	and	< 140
Pre-diabetes: IGT	< 100	and	140 – 199
Pre-diabetes: IFG & IGT	100 – 125	and	140 – 199
Diabetes	≥ 126*	or	≥ 200* (or random sugar)
*A confirmatory test of either a fasting blood sugar, OGTT or random blood sugar with symptoms must be made on another day (except in the case of unequivocal hyperglycemia with metabolic decompensation). ADA= American Diabetes Association IFG = Impaired fasting glucose IGT = Impaired glucose tolerance OGTT = Oral glucose tolerance test

Canadian Glucose Levels to Diagnose
Diabetes & Pre-diabetes

	Fasting Glucose (mmol/L)		2 hr after eating or 75-gram OGTT (mmol/L)
Pre-diabetes: IFG	6.1 – 6.9	and	< 7.8
Pre-diabetes: IGT	< 6.1	and	7.8 – 11.0
Pre-diabetes: IFG & IGT	6.1 – 6.9	and	7.8 – 11.0
Diabetes	≥ 7*	or	≥ 11.1*
*A confirmatory test must be made on another day (except in the case of unequivocal hyperglycemia with metabolic decompensation). IFG = Impaired fasting glucose IGT = Impaired glucose tolerance OGTT = Oral glucose tolerance test

The guidelines blood sugar levels for diagnosing diabetes have changed over the years. They're lower now. And we now have a classification called "pre-diabetes". And this year, the American Diabetes Association (ADA) dropped the level at which you can be classified as having "pre-diabetes". Why? Because at these new "pre-diabetes" glucose levels they are finding damage to the eyes and cardiovascular system.

If you have slightly elevated glucose levels (pre-diabetes) , know this amazing tidbit:

The Diabetes Prevention Study shows that losing 5-7 % of your weight, exercising for 1/2 hr per day and following a healthy diet can reduce your risk of getting diabetes by up to 58%!.

Glucose Guidelines (targets) for Diabetes

ADA

(mg/dl)

AACE

(mg/dl)

CDA

(mmol/L)

Fasting Glucose

70-130

< 110

4 – 7

(4 - 6 if safe is no longer a general guideline)

2 hr after eating

< 180 as peak blood sugar after eating regardless of time

< 140

5 – 10

(5-8 if unable to achieve A1c < 7% and not at risk for hypoglycemia)

A1c

(glycosylated hemoglobin)

< 7%

(< 6% if safe)

< 6.5%

(< 0.065)

<7% (< 0.070)

(<6.5% if need to lower risk nephropathy and weighed against risk for hypoglycemia)

ADA = American Diabetes Association

AACE = American Assoc. Clinical Endocrinologists

CDA = Canadian Diabetes Association

Good News. For people with diabetes, national diabetes associations set these guidelines blood sugar levels (but be sure to check with your physician for your specific guidelines - they can be individualized for important reasons). Blood sugar levels in these target ranges help reduce the risk of developing eye, kidney and nerve damage by up to 40-70%. The landmark studies DCCT (for type 1 diabetes) and UKPDS (for type 2 diabetes) showed this. For various reasons your target levels may be set at different values. Remember to verify your targets with your doctor.

More Good News New research shows that these guidelines blood sugar levels can reduce the risk of heart disease by 50% in type 1 diabetes. The UKPDS study for type 2 diabetes showed a decrease in heart disease with better glucose levels, but unfortunately the decrease was not statistically signficant. We're awaiting type 2 research from the ACCORD study to bring forth new targets and strategies to reduce heart disese in type 2.

Sad News Sadly, the AACE reports 2/3 of the Americans with diabetes do not have their blood sugars in target. This means many of those people will face diminished quality of life by retirement. Or, in the case of children and teens with diabetes (type 1 and YES type 2!) much sooner. :-(

If this is you, please see your doctor or diabetes team to help you achieve better glucose levels. You can also review ideas on how to reach guidelines blood sugar levels when fasting or at lunch , supper , bedtime or 2 hr post prandial.

Good Luck, Good Health! ---Bev

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References:

American Diabetes Association (ADA). Clinical Practice Recommendations. Diabetes Care. 2008: Vol 31 (Suppl 1): S1-108.

Canadian Diabetes Association. 2008 Clinical Practice Guidelines for the Prevention and management of Diabetes in Canada. Can J Diabetes: 2008:32.