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January 22, 2001

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Question from Saudi Arabia:

What should be the maximum and lowest limits of blood sugar for a 50 year old person? What should be the normal upper and lower limits of blood pressure for a 50 year old person?

Answer:

There are no strict limits for either blood sugar or blood pressure. However, when we treat diabetes, we speak of a target range. It is generally accepted that the lower end of the range should be between 60 and 70 mg/dl [3.3 and 3.9 mmol/L] without symptoms. Symptoms include fast heart rate, sweating, palpitations, hunger, and confusion (if severe). Treatment which causes low sugars outside this range, or results in symptoms, should be modified to prevent low sugars. Looking at normal values for individuals without diabetes is more complex, as it has been observed that individuals frequently have values less than 60 mg/dl [3.3 mmol/L] without symptoms.

The upper limit for blood sugar is also important, especially when treating diabetes. There are various levels of control used by a variety of people. I like to tell my patients that normal levels in patients without diabetes are almost always lower than those we see in our patients with diabetes. The reason being that hypoglycemia frequently limits how aggressive we can be. I indicate that fasting glucose levels should be less than 120 mg/dl [6.7 mmol/L], two-hour postprandial blood sugars should be less than 160 mg/dl [8.9 mmol/L], and bedtime blood sugars should be above 100 mg/dl [5.6 mmol/L] to protect against hypoglycemia during the night. Some would also indicate that the pre-meal sugar should be less than 140 mg/dl [7.8 mmol/L]. These are only guidelines and should be modified based on the individual patient, the hemoglobin A1c, and the frequency of hypoglycemia. I would also say that different sources would give you different values which are not necessarily exclusive of the above values.

The goal for blood pressure maintenance should be a value less than 130/80 mm Hg for individuals who have diabetes. This is a more aggressive goal than is commonly given for the general population. It is recommended because of the profound effect hypertension has on the heart, kidney, and vasculature.

JTL