How Age Affects Blood Sugar
Insulin sensitivity declines with age. After 45, the risk of prediabetes and type 2 diabetes increases progressively. This is driven by declining muscle mass (muscle is the primary glucose disposal site), increasing adiposity, and age-related changes in insulin secretion.
Older adults (65+) have relaxed targets. The ADA recommends less stringent glucose targets for older adults — particularly those with limited life expectancy, multiple comorbidities, or cognitive impairment — because tight glucose control increases hypoglycemia risk. Hypoglycemia in seniors can cause falls, fractures, confusion, and cardiac events.
Pregnancy changes everything. Gestational diabetes uses different diagnostic criteria (IADPSG consensus): fasting ≥92 mg/dL, 1-hour OGTT ≥180 mg/dL, or 2-hour OGTT ≥153 mg/dL. A1C is not used for gestational diabetes diagnosis because it underestimates glycemia during pregnancy.
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Tip: If you're over 45, haven't had a blood sugar test in the past 3 years, and have any risk factors (overweight, family history, sedentary lifestyle), request a fasting glucose or A1C at your next checkup. Prediabetes is reversible with lifestyle changes — but only if you know about it. For A1C interpretation, see our A1C to blood sugar converter.