What Is A Normal Blood Glucose Level? Part 2

Dr Jedha, Host

Hello wonderful people, Dr Jedha here and welcome to episode 129.

In episode 127, Part 1 of this series, we tackled one of the biggest misconceptions I see online—that blood sugar levels up to 180 mg/dL, or 10 mmol/L, are somehow considered normal.

We looked at what the research actually says and clarified the difference between normal blood sugar levels and treatment targets that are sometimes recommended for people living with diabetes.

We also explored recommendations from both the American Diabetes Association and the American Association of Clinical Endocrinology. While treatment targets are individualized, the evidence consistently points in the same direction: when blood sugar can be brought closer to the normal range safely, the risk of long-term diabetes complications falls.

If you haven’t listened to Part 1 yet, I’d encourage you to go back and start there because it lays the foundation for everything we’re going to talk about today.

In today’s episode, I want to answer many of the questions that came up after I posted that TikTok video, because there were some fantastic questions amongst all the debate. Plus, I’ve got a very interesting question raised by one of our members recently that I would like to cover as well. We’ll also talk specifically about prediabetes, because the goals are a little different, and I’ll explain why aiming for normal blood sugar levels is so important if you’ve been diagnosed with prediabetes.

So let’s start there. One of the biggest questions I get is this: “If I have prediabetes, what should my blood sugar goals actually be?”

The answer is actually much simpler than many people realize. Your goal should be to return your blood sugar to the normal range.

Now, that might sound obvious, but it’s an important distinction because many people are told that prediabetes is simply something to watch, or that as long as they don’t progress to type 2 diabetes, they’re doing okay. The evidence tells us a different story.

Prediabetes isn’t harmless. Even before someone develops type 2 diabetes, blood sugar levels that sit above the normal range are associated with an increased risk of progressing to diabetes and, over time, an increased risk of complications such as heart disease, kidney disease and nerve damage.

The encouraging news is that prediabetes doesn’t have to be permanent.

In recent years we’ve started talking about something called prediabetes remission, or more accurately, a return to normal glucose regulation. We’ve covered this in episodes 87 and 118. Prediabetes remission simply means bringing your blood sugar back into the normal range and keeping it there.

Why is that so important? Because people who return to normal glucose regulation have a dramatically lower risk of developing type 2 diabetes compared with those who remain in the prediabetes range. In other words, the goal isn’t just to stop your blood sugar getting worse. The goal is to get it back to normal.

So if you’re living with prediabetes, your ideal targets are:

• A normal HbA1c.
• A normal fasting blood sugar.
• A normal two-hour post-meal blood sugar.

Not because those numbers are arbitrary, but because they’re the levels associated with the lowest long-term health risk. And that’s a really hopeful message. Prediabetes isn’t simply about slowing down progression. For many people, it’s an opportunity to completely change the direction of their health before type 2 diabetes develops.

Now, I thought it would be helpful to go through some of the most common ones, because chances are, if one person is wondering it, many others are too.

One of the comments came from Matt, who said, “You’re speaking like everyone has the same levels. We don’t.”

And Matt is right—up to a point. Every person is different. We all have different genetics, different lifestyles, different medical conditions and different responses to food. That’s why treatment plans are best when they are individualized.

But normal blood sugar ranges are not individualized. They’re based on decades of research looking at blood sugar levels in people without diabetes and identifying the levels associated with the lowest risk of complications. So while your journey to getting there may be different from or someone else’s, the definition of normal doesn’t change.

John wrote that he’d been told years ago that 180 mg/dL, or 10 mmol/L, was normal after meals. This is probably one of the biggest sources of confusion. As we discussed in Part 1, that number isn’t a definition of normal blood sugar. It’s a treatment target that appears in some diabetes guidelines for certain people with diabetes.

Normal blood sugar after a meal is below 140 mg/dL, or 7.8 mmol/L. Treatment targets and normal physiology are two completely different things, and it’s important not to confuse them. And we also discussed that to achieve a healthier A1c, a postmeal level of 180 or 10 may likely make it much more difficult.

Another interesting question came from Quinlan, who asked, “Do the people who decide these levels actually live with diabetes?”

It’s a fair question. The answer is that these numbers aren’t based on opinion or personal experience. They’re based on decades of scientific research involving hundreds of thousands of people. Researchers look at where the risk of diabetes complications begins to increase, they examine long-term health outcomes, and expert panels review all of that evidence before making recommendations.

So while lived experience is incredibly valuable, diagnostic cut-offs and treatment guidelines have to be based on scientific evidence if they’re going to protect people’s health.

Komal asked why some countries say the upper limit of normal fasting blood sugar is 5.5 mmol/L, while others use 6.0 mmol/L, for example in the UK, Canada, Australia. It’s actually not that the normal fasting level is different, it’s the diagnostic cutoff that may be different. Let me explain this. In the US, prediabetes is diagnosed with fasting glucose of 100 to 125 and below 100 is normal. For most other places in the world, prediabetes is diagnosed with a fasting glucose of 6.1 – 6.9, while 6.0 or below is considered normal.Technically however, if you were to get a lab report, it would still highlight fasting glucose as elevated if it were above 5.5 but it wouldn’t necessarily result in a prediabetes diagnosis. This can be a bit confusing. Essentially, it comes down to slight differences in guideline recommendations. The important thing is not to get caught up in tiny differences of a few decimal points.

Whether your local guideline uses 5.5 or 6.0 mmol/L as the upper limit of normal, the overall message is exactly the same: lower blood sugar within the normal range is associated with better long-term health.

Reena asked, “If I have insulin resistance, what should my blood sugar be?”

The answer is exactly the same. Insulin resistance doesn’t create a new definition of normal blood sugar. If your blood sugar is consistently above the normal range, that’s when we start thinking about prediabetes or type 2 diabetes. But if you have insulin resistance without diabetes, your goal is still to keep your blood sugar within the normal range.

Abdul asked, “What’s a normal random blood sugar?”

Generally speaking, a random blood sugar below 140 mg/dL, or 7.8 mmol/L, is considered normal, although random readings are less useful than fasting blood sugar, post-meal readings and HbA1c because they depend on when and what you’ve recently eaten.

So hopefully that’s already cleared up a few of the biggest misconceptions.

Let’s look at some common concerns. 

Sandra said, “I’ll never get down to 140 mg/dL, or 7.8 mmol/L, two hours after meals.”

Sandra, if that’s where you’re starting today, don’t feel discouraged.  It might seem like a number you can’t achieve but believe me, if you keep at it, you will be pleasantly surprised. Remember, blood sugar may not improve overnight. The goal isn’t perfection from day one—it’s gradual progress over time.

The biggest influence on your blood sugar after meals is the amount and type of carbohydrate you eat. By making changes to your food choices, paying attention to portion sizes and finding an eating pattern that works for you, those numbers often improve far more than people expect. You only have to listen to our member stories we’ve heard on the podcast or visit our website to read others to see how powerful your nutrition and lifestyle plan really is Keep measuring, keep learning and keep making small improvements. Every step in the right direction matters.

Frank said, “Under 100 mg/dL, or 5.6 mmol/L, is too low. I feel shaky.”

This is actually quite common. True hypoglycemia, or genuinely low blood sugar, is generally considered to be below 70 mg/dL, or 4.0 mmol/L.

However, if your blood sugar has been running high for months or even years, your body can become accustomed to those higher levels. So when your blood sugar starts returning to the normal range, you may temporarily feel shaky, light-headed or generally unwell, even though your blood sugar isn’t actually low.

The good news is that, for most people, this feeling settles as the body readjusts to healthier blood sugar levels. Of course, if you’re taking medications that can cause hypoglycemia, such as insulin or sulfonylureas, it’s important to work closely with your healthcare team because your medications may need adjusting as your blood sugar improves.

Now, probably the most common comment to this TikTok video was some version of: “Everyone’s different.”

And that’s absolutely true. Everyone’s journey is different. Some people lower their HbA1c quickly. Others take months or even years. Some people may need medication. Others can achieve excellent results with nutrition and lifestyle changes. Others want to work toward reducing or stopping their medications, which is what we help many of our members do. Some people have other health conditions that mean their treatment targets need to be adjusted. But none of that changes what normal blood sugar is.

Normal blood sugar isn’t based on opinion, social media or individual experiences. It’s based on decades of scientific research showing the blood sugar levels associated with the lowest risk of diabetes complications.

So yes, we’re all different. But the science is remarkably consistent. When it can be achieved safely, bringing blood sugar back to normal or as close to the normal range as possible is one of the best things you can do for your long-term health.

Before we move on to a few more interesting questions, let’s hear a testimonial from one of our members.

Okay, so one of our members brought up an interesting point in the last member check in. We hold these every month for people to share their progress, challenges and questions and receive feedback and support. 

My question regards A1C numbers as to what is “normal” and what should be a concern. I am 85 yrs old closer to turning 86. My primary doctor’s lab has returned the past two testing periods results marked as “out of range.” When I went on the patient portal and asked my doctor what that means his response was don’t worry about it, live your life. That was not an acceptable answer for me. When I pressed he said the A1C this previous 3 month period was 6% but for my age up to 7% is normal. I was alarmed at that answer. I consider anything past 6.2% to be a concern. All the testing results in the various categories all were marked “out of range.” Please give me clarity with your thoughts on the topic.

Thank you for your question because I know there are many older listeners wondering exactly the same thing, and it perfectly illustrates why this topic is so important.

The first thing I’d say is that an HbA1c of 6% is not a ‘bad’ result. In fact, depending on which country you live in, it’s either still considered normal or right on the border of the prediabetes range.

However, the important point is this: Normal doesn’t change with age.

The definition of normal glucose remains the same whether you’re 40, 60 or 85. What does change is the treatment goal that your healthcare team may recommend.

For example, organizations such as the American Association of Clinical Endocrinology say that for most people, the goal should be an HbA1c below 6.5%, or as close to normal as is safe and achievable. However, they also acknowledge that less stringent targets may be appropriate for people with significant medical problems, frailty or limited life expectancy.

Similarly, the American Diabetes Association recommends more relaxed targets for some older adults, particularly those with multiple health conditions or where the risks of intensive treatment, such as hypoglycemia, may outweigh the benefits. So your doctor wasn’t inventing those numbers. They do appear in clinical guidelines. We do have less research in people 80+, but if overall a person is healthy, there is no data to say they should be treated any differently. For a long healthy life, maintaining glucose as close to normal as possible, appears to be the ideal goal. ADA guidelines recognize this as well. 

Where I think the conversation could have been better is that those recommendations should always be individualized. Chronological age is only one part of the picture.  I’ve met people in their 80s who are incredibly active, independent and otherwise very healthy. I’ve also met people much younger with multiple serious health conditions.

The discussion should really be, “What are your goals, what is your overall health like, and what can we safely achieve?”

If someone is otherwise healthy and wants to improve their blood sugar further, I think that’s a perfectly reasonable conversation to have with their healthcare team. But, the response from the doctor sounds a mentality of thinking…well, you’re an elderly person and probably don’t have that long to live so just go and enjoy life. In my opinion, it’s not the place of a doctor to assume that you have a limited life span just because you’re 86. We see many people live very long and healthy lives now, so that’s not a great recommendation or response and there should have been a discussion and conversation about goals. Person centered treatment with shared goals with you, most important, you are in the driver’s seat of your health, and with your doctor or healthcare team. 

Regardless of age, the evidence we’ve discussed in episodes 127 and 129 consistently show that bringing blood sugar closer to the normal range is associated with a lower risk of complications. That doesn’t mean everyone should be pushed toward the same target, but it does mean that if achieving a lower HbA1c is safe, practical and aligns with the person’s goals, it’s certainly worth discussing.

And as I said, I wouldn’t be alarmed by an HbA1c of 6%. It’s still reasonable. But if it has increased and the goal is to lower it, I’d get curious. Ask yourself some questions and explore. Has anything changed in your lifestyle, medications or overall health? Could there be opportunities to improve it through nutrition, physical activity or other lifestyle changes? What you could add/subtract/change/modify in your routine to improve it, if a lower number feels like a better goal for you.

Those are the kinds of conversations I’d want to be having, rather than simply being told, “Don’t worry about it.” Because at the end of the day, it’s your health, your goals and your quality of life that matter.

I hope you’ve found this short series on normal blood sugar and A1c levels insightful. Remember, you can submit your topics and questions to Type2DiabetesTalk.com/message

That’s all from me today. 

Dr Jedha, over and out.