Did you know, in the United States, more than 29% of adults aged 65 years and older are living with diabetes? This includes both diagnosed and undiagnosed seniors. According to the Centers for Disease Control and Prevention (CDC), diabetes is the 7th leading cause of death.
If you are a senior and have recently been diagnosed with either prediabetes or type 2 diabetes, you may be bombarded with statistics such as these. You may also be receiving lots of information from your healthcare team regarding keeping your blood sugar and HbA1C levels within a healthy range. This overload of information can be quite overwhelming!
But, it doesn’t have to be.
The HbA1c test is a crucial piece of information for your healthcare team regarding the state of your blood sugar levels. It is mainly used to diagnose and manage prediabetes and type 2 diabetes. This blood test looks at the amount of glucose (sugar) that is attached to Hemoglobin, a protein found in red blood cells, over the course of 2-3 months. This is the lifespan of a red blood cell. The higher the amount of sugar attached to hemoglobin, the higher the HbA1c level. The higher the HbA1c level, the greater the risk of developing type 2 diabetes and diabetes-related complications long term.
While HbA1c results can be a crucial component for your healthcare team to monitor long-term glycemic control and to even help lower blood sugar levels, maintaining a healthy lifestyle, including medication, nutrition, and movement can also help! All of these factors can assist your care team to develop a proper diabetes management plan specifically designed for you!
Read on to discover the significance of the HbA1c test, what are considered “normal” HbA1c readings in seniors, and how vital it is to maintain a healthy lifestyle through medication, nutrition and exercise.
Normal HbA1c Levels for Seniors
HbA1c levels for older adults can either be viewed as either a percentage or as a Fasting Plasma Glucose (FPG) range. The FPG test evaluates your blood sugar levels after you haven’t eaten anything for 8 hours or more.
The table below is a helpful reference and shows the comparison between the two test results. As you can see, diabetes is diagnosed if the HbA1c percentage is 6.5% or higher or if the Fasting Plasma Glucose is 126 mg/dL or higher.
Normal: A1c Less than 5.7% / Fasting Plasma Glucose (mg/dL) Less than 100
Prediabetes: A1c of 5.7% to 6.4% / Fasting Plasma Glucose (mg/dL) 100 – 125
Diabetes: A1c 6.5% or higher / Fasting Plasma Glucose (mg/dL) 126 mg/dL
Here is a handy printable HbA1c chart and calculator to make it easy to monitor your levels at home, in between healthcare visits!
Another option is the Fructosamine test, which tests your blood sugar levels across a two-three week time frame. This is an accurate test for seniors who may have certain health conditions, such as renal (kidney failure), but does not actually screen for diabetes.
Prediabetes in Seniors
If you’ve recently been diagnosed with prediabetes, and you’re 65 years old or older, you may be feeling worried, anxious, and vulnerable. It is common, however, for seniors to have slightly higher blood sugar levels due to the fact that your body naturally makes less insulin and processes it less efficiently as when you were younger.
Even studies have shown that you may not need to worry about shifting to full-blown type-2 diabetes, after all!
The newest CDC study (published in April 2022) looked at almost 50,200 patients that were at least 65 years old and had been diagnosed with prediabetes. Over 8 years, only 5.3% of the patients progressed from prediabetes to diabetes annually.
Another recent study of more than 3,400 seniors showed that over 6.5 years, less than 12% of them progressed from prediabetes to diabetes.
Still, it is very important to adopt a healthy lifestyle which includes having a balanced nutrition plan in place, incorporating daily enjoyable movement and staying hydrated!
A senior’s functional status is a reliable indicator of their capacity to complete daily tasks, care for themselves, and successfully manage their diabetes. Independence and quality of life are so important as we age!
“Basic Activities of Daily Life” and “Instrumental Activities of Daily life” are measurements that help to determine the functional status of a senior. The factors mentioned below can help determine if an individual is able to manage their own HbA1c levels or if they need further assistance from their healthcare team.
Basic Activities of Daily Life:
Instrumental Activities of Daily Life:
- Managing finances
- Managing medications
Shown below is how the functional status of seniors direct correlates to HbA1c percentage goals, according to the International Diabetes Federation (IDF)
Can function independently
HbA1c Goal (%) = 7 – 7.5
Cannot function independently, (frailty, Dementia)
HbA1c Goal (%) = 7 – 8
Normal HbA1c and Blood Sugar Targets
Knowing your blood sugar levels when you self-monitor at home using a conversion chart is crucial. This can help you avoid low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia) episodes, both of which can lead to untimely accidents in the home, such as falling or fainting.
The device that you use, whether a CGM or glucometer, will show you your blood sugar level at the moment of testing. This is called your Estimated Average Blood Sugar (eAG).
It is very helpful to know if your blood sugar level is near your target HbA1c. For example, if your healthcare team has set a HbA1c goal for you to 6%, then you will want your device to show an average reading of 126 mg/dL (7 mmol/L).
|HbA1c (%)||Estimated Average Blood Sugar (mg/dL)|
|6%||126 mg/dL (7 mmol/L)|
|7%||154 mg/dL (8.6 mmol/L)|
|8%||183 mg/dL (10.2 mmol/L)|
|9%||212 mg/dL (11.8 mmol/L)|
|10%||240 mg/dL (13.4 mmol/L)|
|11%||269 mg/dL (14.9 mmol/L)|
|12%||298 mg/dL (16.5 mmol/L)|
There is a strong relationship between high HbA1c readings and the risk of developing diabetes-related complications.
A diabetes diagnosis increases the risk of developing the following:
- Hearing loss
- Vision loss
- Urinary incontinence
- Fall risk
- Functional limitations
Living Environment and Personal Characteristics
Your living environment and personal characteristics may also be playing a role in successful management and care of your diabetes.
- Senior housing community environment: If you are living in a community environment outside of a nursing home and can function independently, then you may be given a more intricate diabetes regimen. This can impact your diabetes management goals, however, if you are unable to follow the regimen due to its complexity. It is extremely important, therefore, to be frank with your care team about your comfort levels with the diabetes plan.
- Nursing home: If you are living in a nursing home and you cannot function independently, then you will more than likely have to rely on staff and family members to time your meals and prepare meals that support your diabetes diagnosis. Being unaware of what meals you will be served and when they will arrive may put you at higher risk of diabetes mismanagement, especially low blood sugar episodes. Again, be clear with your healthcare team if you feel you are not in control of your management plan, and would like some more autonomy.
Managing Normal HbA1c Levels for Seniors
When regulating or lowering your blood sugar and HbA1c levels, there are many important elements for seniors to take into account, including nutrition, exercise, and medication.
- Nutrition: Balancing and controlling what you eat and how often you eat are both important factors when it comes to diabetes management. A diabetes meal plan for seniors should include 3 balanced meals a day at approximately the same time each day. These meals should consist of lean protein, healthy fats, and high fiber carbohydrates. Lean protein examples include poultry, tofu, eggs, nuts, nut butter, beans, legumes, and lentils. Healthy fats include avocados, nuts and seeds, and olive oil. High fiber carbohydrates should be complex carbohydrates. Those include beans, lentils, whole grains, fruits, and vegetables.
- Exercise: Daily exercise can help lower your blood sugar levels, maintain a healthy blood pressure, improve your balance and fall risk, and can even help you sleep better! According to the American Diabetes Association, it is recommended to get 150 minutes or more of moderate-intensity exercise each week. Remember to always work with your healthcare team to co-create an exercise routine that is realistic for your specific goals. If you have previously led a sedentary lifestyle, start slowly, and gradually build up your stamina! It’s not a marathon!
Here are some great exercise ideas for seniors living with diabetes:
- Water aerobics
- Weight training
- Group workout activities
- Medication: To help you manage your diabetes and lower your HbA1c, your healthcare team may prescribe specific medications.
Common medications for diabetes management in seniors are the following:
- Insulin Sensitizer Drugs (ISD): Such as Metformin and thiazolidinediones, which help to normalize blood sugar
- Insulin Releasing Drugs (IRD): Such as sulfonylureas, which help to lower your blood sugar
- Alpha Glucosidase Inhibitors (AGIs): Which help to manage and treat type 2 diabetes
- Incretin-based medications: Such as DPP-4 inhibitors, which mimic your gut hormones (incretins) that help to control your blood sugar levels while also helping digestion
Managing and lowering blood sugar and HbA1c levels can be a harrowing experience for seniors. Functional status, HbA1c goals, health complications, and living environment all contribute to how well seniors manage their diabetes. Having a balanced nutritional meal plan that includes high fiber carbohydrates, lean proteins, and healthy fats, combined with regular daily exercise are great starting points for managing your condition, and for lowering blood sugar levels. Medications are always an option that your healthcare team may turn to if additional help is needed.
As always, if you ever have any questions or concerns on how to lower your blood sugar and HbA1c levels, be sure to consult your health care team to help navigate any uncertainty you may be facing.
If you’ve been diagnosed with type 2 diabetes and looking for help managing your condition—we’re here for you. CopilotIQ offers unlimited access to a personal nurse that will work with you to create a personalized plan to reach your health goals. The services are covered by Medicare and you can talk to a nurse today.