2012 Guidelines for Blood Sugar Levels

Newest Guidelines for Blood Sugar Levels (NOT for Diabetes in Pregnancy): Normal Range Blood Sugar Levels American Diabetes Association Glucose Levels to Diagnose Diabetes & Pre-diabetes Canadian Levels to Diagnose Diabetes & Pre-diabetes Glucose Guidelines (targets) for Diabetes

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This page discusses guidelines for blood sugar levels used by the American and Canadian Diabetes Associations for the diagnosis and treatment of diabetes. This includes indications and contraindications for the use of A1c (glycated hemoglobin)in the diagnosis of type 2 diabetes. Normal glucose levels are listed first, as people diagnosed with hyperglycemia frequently present to the diabetes educator requesting this information.

Normal Range of Blood Sugar Levels

*Notethat in the U.S., the value for normal fasting glucoseis less than that in Canada. 100 mg/dl converts to 5.6mmol/L.
Normal range blood sugar levels have been harder to define over the years as research continues to reveal that slight elevations in blood glucose are associated with increased risk to arteries that can result in eye damage, heart attack and stroke --even before people get diabetes. These slight elevations in blood glucose are now termed "pre-diabetes" and as expected, put people at increased risk of developing diabetes. To help identify those at higher risk of diabetes, the Canadian Diabetes Association guidelines suggest a 75 g oral glucose tolerance test (OGTT) be completed in people with a fasting glucose of 5.7-6.9 mmol/L. This test requires a sweet glucose drink be consumed in the fasting state, followed by a blood glucose test every 1/2 hour for 2 hours. The results of this diabetes screening test are more reliable than the fasting glucose alone. A significant 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. It's important to note that once diagnosed with diabetes, this test is unnecessary and does not need to be repeated again.

Glucose Levels (Diagnostic Criteria) for Diagnosing Diabetes

The most recent change to the diagnosis of diabetes includes the use of a blood test called the A1c or glycosylated hemoglobin. In the United States, the A1c has also been recommended for use in identifying those with pre-diabetes. It is important to note that the A1c is not considered appropriate for use as a diagnostic tool in those with type 1 diabetes, children, adolescents, pregnant women, those with severe liver or kidney failure or those with conditions that affect the lifespan of red blood cells.

American Diabetes Association Glucose Levels to Diagnose Diabetes & Pre-diabetes

***FastingGlucos e 75-gram OGTT (mg/dl)

5.76.4 %

Diabetes
(or randomsugar)

or

(mmol/L )

2 hr aftereatin g or (mmol/L)

A1 c

Prediabetes: IFG Prediabetes: IGT Prediabetes :

6.1 6.9

and

< 7.8

--

< 6.1

and

7.8 11.0

--

7*

or

11.1 *

or

>6.5% *

*A confirmatory test must be made on anotherday (except in the case of unequivocal hyperglycemiawith metabolic decompensation). IFG = Impaired fasting glucose IGT = Impaired glucose tolerance

OGTT = Oralglucose tolerance test

American DiabetesAssociation Guidelines for Blood Sugar Levels forDiagnosing Diabetes & Pre-diabetes References: Goldenberg,RM et al. Canadian Diabetes Association PositionStatement: Use of glycated hemoglobin (A1c) in thediagnosis of type 2 diabetes. Can J Diabetes2011: 35(3)247-249 CanadianDiabetes Association. 2008 Clinical PracticeGuidelines for the Prevention and management ofDiabetes in Canada. Can J Diabetes 2008:32(supplement1): S1-S201

Guidelines for Glucose Targets in Diabetes (Adult, Non-Pregnant)

2 hr after eating

< 180 as peak blood sugar after eatingregardless of time

5 10
(glycosylated hemoglobin)

< 7%
Note: Target is <6.5% if itcan be achieved safely and taking other medical andpsycosocial factors into consideration Notes: <6.5% if need to lower risk nephropathyand weighed against risk for hypoglycemia)

ADA = American Diabetes Association AACE = American Assoc. ClinicalEndocrinologists

CDA = CanadianDiabetes Association American Diabetes Association. Standards of Medical Care inDiabetes. Diabetes Care; 2012: 35 ( Supplement1):S11-S63 CanadianDiabetes Association. Clinical PracticeGuidelines for the Prevention and management ofDiabetes in Canada 2008. Can J Diabetes; 2008:32(supplement1): S1-S201

Good News Blood sugar levels in these target ranges for people with diabetes can 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 In type 1 diabetes, the EDIC trials (a continuation of the DCCT) showed that those with long-standing good blood sugar control had about 50% less cardiovascular disease, heart attacks, stroke or death by cardiovascular disease than those with less history of acceptable A1c levels. In type 2 diabetes, the research is not as clear except the summary messages keep repeating that the earlier good blood sugar control is reached after diagnosis, assuming no cardiovascular disease at the time of diabetes diagnosis, the less the risk for cardiovascular disease in later years. Take this to mean, don't procrastinate. Aim to control blood sugars to individualized targets as soon as possible after diagnosis, whether you have type 1 or type 2 diabetes. Be sure to review appropriate glucose targets with your doctor. Also, please remember that the control of blood pressure and cholesterol (namely LDL) is critical and frankly more powerful in the prevention of heart attack and stroke for most individuals with diabetes. Do not rely solely on blood sugar control. Please, do not be discouraged that blood pressure and LDL cholesterol management typically requires not just lifestyle changes, but also medication in those with diabetes. Sad News Sadly, the American Association of Clinical Endocrinologists reports that 2/3 of Americans with diabetes do not have their blood sugars in target levels. As a result, many with diabetes may face a diminished quality of life by retirement or earlier, considering that diagnosis in children and teens is increasing. Please, see your doctor or diabetes team to help you achieve better glucose levels. You can also review ideas with your health care team on how to reach the blood sugar levels outlined in guidelines when fasting or at lunch , supper , bedtime or 2 hr post prandial. Good Luck, Good Health!

To Home from Guidelines blood sugar levels. References: American Association of Clinical Endocrinologists. AACE Diabetes Care Plan Guidelines 2011;17(Suppl 2):1-53 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2012;35(Suppl 1):S64S71 Canadian Diabetes Association. 2008 Clinical Practice Guidelines for the Prevention and management of Diabetes in Canada. Can J Diabetes 2008: 32(supplement1): S1-S201 Goldenberg, RM et al. Canadian Diabetes Association Position Statement: Use of glycated hemoglobin (A1c) in the diagnosis of type 2 diabetes. Can J Diabetes 2011: 35(3)247-249