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METABOLIC BASICS | ULTIMATE GUIDE

What should your

glucose levels be?
Here’s the ultimate
guide to healthy blood
sugar ranges
Fasting glucose levels classify into 3
categories: normal, prediabetes, and
diabetes. To be considered “normal,”
fasting glucose must be under 100 mg/dl.

AUTHOR AUTHOR
Casey Means, MD Chimene Richa, MD
UPDATED: 06/29/2023
16 MIN READ
PUBLISHED: 04/15/2020

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ARTICLE HIGHLIGHTS

· This article reviews the standard clinical

criteria for normal glucose levels.

· Given the growing use of continuous glucose

monitors (CGM) in research studies, we give
an overview of data on glucose patterns in
nondiabetic individuals wearing CGM.

· Standard tests to assess glucose levels

include fasting glucose test, 3 month average
glucose levels test (hemoglobin a1c), and an
oral glucose tolerance test. These data points
are momentary snapshots, and do not give
insight into what is happening to an
individual’s highly dynamic glucose level over
time and whether these trends are healthy.

· CGM goes further by showing continuous

data about daily glucose trends, but there is
no clinical consensus yet on goal 24-hour
glucose levels for a nondiabetic individual.

· Our analysis of the research literature distills

insights about what may be safe and optimal
ranges to strive for throughout a 24-hour cycle
for a healthy, nondiabetic individual, and
propose a series of glucose ranges that can
be helpful to orient around when determining
what to strive for on a day-to-day basis while
using CGM.

· Based on the data of healthy individuals

wearing CGM, it appears that it is safe and
healthy to strive for a fasting glucose between
72-85 mg/dL, a post-meal glucose level of 110
mg/dL or lower, and an average glucose of 100
mg/dL or lower.

What’s considered a
“normal” glucose level?
Your doctor will likely test your blood glucose
levels as a screening test for diabetes during a
standard yearly check-up. Additionally, many
people track their glucose at home with an over-
the-counter finger-prick test. When you check
blood glucose (also called blood sugar), either at
a doctor’s office or with a home finger stick
glucose monitor, the results are in milligrams
(mg) of glucose per deciliter (dL) of blood. (Note
that in many countries, the standard
measurement is mmol/L; to convert the values
below to mmol/L, divide the mg/dL by 18.)

One of the most common glucose

measurements is fasting plasma glucose (FPG)
or fasting blood glucose (FBG), and it’s found by
checking blood glucose levels after not having
any calories at least eight hours before the test.
According to the American Diabetes Association
(ADA), people can be classified into three
categories depending on their fasting plasma
glucose levels: normal, prediabetes, and
diabetes. To be considered “normal,” fasting
glucose must be under 100 mg/dl.

Post-meal glucose levels are also meaningful,

and high post-meal glucose levels can worsen
glucose control over time and lead to obesity,
diabetes, cardiovascular disease, and impaired
exercise and cognitive performance. While it is
not unexpected for glucose levels to increase
after a meal as the glucose from the meal is
released into the blood, if this level is too high, it
is not good for health and can predispose one to
disease over time. According to the International
Diabetes Federation (IDF) guidelines for
managing post-meal glucose levels, nondiabetic
people should have a glucose level of no higher
than 140 mg/dl after meals, and glucose should
return to pre-meal levels within 2-3 hours. Post-
meal hyperglycemia (elevated glucose) is
defined as a glucose level >140 mg/dl 1-2 hours
after the ingestion of food or drinks.

These glucose measurement methods

mentioned so far rely on a single point-in-time
measurement to determine if your levels are
normal. Recent advances in continuous glucose
monitoring (CGM) technology allow you to track
your glucose levels over a 24-hour period and
gain insight into deeper trends associated with
health, such as glycemic variability, a measure of
the up-and-down swings in glucose throughout
the day. However, there are no standardized,
universally accepted criteria for what “normal”
24-hour glucose values are using CGM
technology. Scientists are continuing to gather
information about glucose levels in healthy
people using CGM technology.

Of note, CGM devices measure interstitial

glucose levels (glucose from the fluid in between
cells) compared to blood/plasma glucose levels
(glucose in the blood) measured in the FPG
tests. While interstitial glucose and
blood/plasma glucose levels correlate highly,
they are not precisely the same, and diagnoses
are not made from interstitial measurements.

Below is a summary overview of data about 24-

hour glucose trends in nondiabetic individuals
wearing CGM to gain a better understanding of
“what’s normal.”

Learn more:

INSIDE LEVELS

10 common questions about CGMs

answered
The Levels Team

CGM Studies In People

without Diabetes
One study from 2009 entitled “Reference Values
for Continuous Glucose Monitoring in Chinese
Subjects” looked at the glucose levels of 434
healthy (people without diabetes or obesity)
adults using CGM and found the following:

On average, their daily glucose levels stayed between 70–140

mg/dl for 93% of the day, with very small portions of the day

spent above 140 mg/dl or below 70 mg/dl.

Also, their mean 24-hour glucose levels were around 104

mg/dl (± 10 mg/dl)

1-hour post-meal glucose values average 121-123 mg/dl for

breakfast, lunch, and dinner

3-hour post-meal glucose values were around 97-114 mg/dl.

Peak post-meal values appeared to be around 60 minutes

after eating.

Mean fasting glucose was 86 ± 7 mg/dl.

Mean daytime glucose was 106 ± 11 mg/dl.

Mean nighttime glucose was 99 ± 11 mg/dl.

A 2010 study, “Variation of Interstitial Glucose

Measurements Assessed by Continuous
Glucose Monitors in Healthy, Nondiabetic
Individuals,” looked at a healthy population of 74
people that included children, adolescents, and
adults during daily living using CGM. This
research showed that:

Glucose levels stayed between 71-120 mg/dl for 91% of the

day.

Levels were lower than 70 mg/dl for 1.7% of the time and

greater than 140 mg/dl, only 0.4% of the time.

Mean 24-hour glucose was 98 ± 10 mg/dl.

Mean fasting glucose of 86 ± 8 mg/dl.

Compared to the first study mentioned, these

healthy, nondiabetic individuals appeared to
have a tighter range of glucose, spending the
vast majority of the 24-hour period between 71-
120 mg/dl.

A third study, from 2008, entitled

“Characterizing Glucose Exposure for Individuals
with Normal Glucose Tolerance Using
Continuous Glucose Monitoring and Ambulatory
Glucose Profile Analysis,” looked at 32
individuals with normal glucose tolerance
wearing CGM for approximately 29 days and
showed the following findings:

Amongst all participants, 24-hour glucose average ranged

from 94 mg/dL to 117 mg/dL

Overall mean glucose level was 102 +/- 7 mg/dL

Mean daytime glucose was 105 ± 8 mg/dL

Mean nighttime glucose was 97 ± 6 mg/dL

Participants spent 93% of time between glucose values of

70-140 mg/dL, with 3% of the time below 70 mg/dL on

average and 4% of the time above 140 mg/dL on average

Looking at people in the study, some spent as little as .3% of

the time (4 minutes per 24 hours) at values > 140 mg/dL

Some healthy people in the study spent approximately 2.8

hours per 24 hours at glucose values <70 mg/dl, and an hour
< 60 mg/dL

Learn more:

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about your diet
The Levels Team

A fourth study, “Continuous Glucose Monitoring

Profiles in Healthy Nondiabetic Participants: A
Multicenter Prospective Study,” from 2019,
examined 153 healthy, nondiabetic children and
adults ages 7-80 with normal mean BMI of 24 ±
3.2 kg/m2 wearing CGM for up to 10 days. This
study showed:

Mean glucose levels of 99 ± 7 mg/dL

Standard deviation of glucose levels of 17 ± 3 mg/dL

Zero glucose readings >180 mg/dL

89% of glucose sensor values fell between 70-120 mg/dL

96% of glucose sensor values fell between 70-140 mg/dL

2.1% of glucose sensor values were >140 mg/dL

1.3% of glucose sensor values were <70 mg/dL

A 2007 study, “Continuous Glucose Profiles in

Healthy Subjects under Everyday Life Conditions
and after Different Meals,” looked at 21 healthy
young people using CGM. These participants
were between ages 18-35, had a healthy BMI of
22.6 ± 1.7 kg/m2, and were examined eating
standardized meals as well as regular meals of
their choosing. Mean fasting glucose for these
participants was 80 mg/dL. This study found:

Under everyday life conditions:

Mean 24-hour glucose concentration was 89.3 ± 6.2 mg/dL

(range 79.2-101.3 mg/dL)

Mean daytime glucose was 93 ± 7.0 mg/dL

Mean nighttime glucose was 81.8 ± 6.3 mg/dL

Participants spent ~80% of the time between glucose values

59-100 mg/dL, and only 20% of the time between 100-140

mg/dL

Glucose was above 140 mg/dL for only 0.8% of the day

Mean pre-meal glucose levels were 79.4 ± 8.0 to 82.1 ± 7.9

mg/dL

Mean time to post-meal glucose peak was between 46 and

50 minutes

Mean peak post-meal glucose levels of 132 ± 16.7 mg/dL at

breakfast, 118 ± 13.4 mg/dL at lunch, and 123 ± 16.9 at dinner

Under standardized meal conditions with a

moderately low percentage carbohydrate (50
grams, 26.8%), high fiber (12.8g), high-fat meal
(47 grams, 56.7% fat), and high protein (30.9
grams, 16.5%), participants displayed:

Mean peak post-meal glucose levels of 99.2 ± 10.5 mg/dL

Mean post-meal change from baseline of 20.2 ± 7.2 mg/dL

Mean time to peak was 57.5 ± 24.5 minutes

Finally, the 2018 paper, “Continuous glucose

monitoring is more sensitive than HbA1c and
fasting glucose in detecting dysglycaemia in a
Spanish population without diabetes,” assessed
254 people with normal glycemic function
wearing CGM for 2-5 days. The mean BMI of
these participants was overweight, at 27.3 ± 4.7
kg/m2. Their results found:

Means fasting glucose of 84.6 ± 7.2 mg/dL

Mean 24-hour glucose was 104.4 mg/dL

Mean daytime glucose was 106.2 mg/dL

Mean nighttime glucose was 102.6 mg/dL

Participants spent 97% of the time between 70-140 mg/dL

Participants spent 1.6% of the time above 140 mg/dL

9.7% of participants had post-meal (breakfast and lunch)

glucose levels that reached >140 mg/dL

12.1% of participants had post-meal (dinner) glucose levels

that reached >140 mg/dL

Summary Of Normal
Glucose Ranges
In summary, based on ADA criteria, the IDF
guidelines, a person’s glucose values are
“normal” if they have fasting glucose <100
mg/dL and a post-meal glucose level <140
mg/dL. Taking into account additional research
performed specifically using continuous glucose
monitors, we can gain some more clarity on
normal trends and can suggest that a
nondiabetic, healthy individual can expect:

Fasting glucose levels between 80-86 mg/dL

Glucose levels between 70-120 mg/dL for approximately 90%

of the day (and to rarely ever go above 140 mg/dL or below

60 mg/dL)

24-hour mean glucose levels of around 89-104 mg/dL

Mean daytime glucose of 83-106 mg/dL

Mean nighttime glucose of 81-102 mg/dL

Mean post-meal glucose peaks ranging from 99.2 ± 10.5 to

137.2 ± 21.1 mg/dL

Time to post-meal glucose peak is around 46–60 minutes

These are not standardized criteria or ranges but

can serve as a simple guide for what has been
observed as normal in people without diabetes.

Beyond “normal” goals:

What’s an “optimal”
glucose level, and why
does it matter?
Exact numbers for what is considered “optimal”
glucose levels to strive for while using CGM to
achieve your best health are not definitively
established; this is a question that is individual-
specific and should be discussed with your
healthcare provider. With that said, research
shows that there is an increased risk of health
problems as fasting glucose increases, even if it
stays within the “normal” range, making finding
your “optimal” glucose levels all the more
important.

While the International Diabetes Federation and

other research studies have shown that a post-
meal glucose spike should be less than 140
mg/dL in people without diabetes, this doesn’t
determine what value for a post-meal glucose
elevation is truly optimal for your health. All that
number tells us is that in nondiabetics doing an
oral glucose tolerance test, researchers found
that these people rarely get above a glucose
value of 140 mg/dL after meals.

So, while this number may represent a proposed

upper limit of what’s “normal,” it may not indicate
what will serve you best from a health
perspective. Many people may likely do better at
lower post-meal glucose levels. Similarly, while
the ADA states that a fasting glucose less than
100 mg/dL is normal, it doesn’t indicate what
value is optimal for health.

Lastly, there are no specific recommendations

regarding the average glucose levels over a 24-
hour period using CGMs. This lack of
standardization is likely because CGMs are
relatively new and not widely used in a non-
diabetic population.

“Repeated high
glucose spikes after
meals contribute to
inflammation, blood
vessel damage,
increased risk of
diabetes, and
weight gain.”
The following is a summary of insights from our
review of the research. You should consult with
your doctor before setting any glucose targets or
changing dietary and lifestyle habits.

Levels Proposed
Optimal Glucose Values

Fasting Glucose Goal: 72-85 Mg/dL

Why? Previously we discussed that the ADA
considers normal fasting glucose as anything
<100 mg/dl. However, multiple research studies
show that as fasting glucose increases, there is
an increased risk of health problems like
diabetes and heart disease — even if it stays
within the normal range. The highlights of some
of the study results include:

Men whose fasting blood glucose was greater than 85 mg/dL

had a significantly higher mortality rate from cardiovascular

diseases than men with blood sugars less than 85 mg/dL.

(Bjornholt et al.)

People with fasting glucose levels in the high normal range

(95-99 mg/dL) had significantly increased cardiovascular

disease risk than people whose levels remained below 80

mg/dL. (Park et al.)

Children with fasting glucose levels of 86-99 mg/dL had

more than double the risk of developing prediabetes and

Type 2 diabetes as adults when compared with children

whose levels were less than 86 mg/dL. (Nguyen et al.)

People with fasting glucose levels between 91-99 mg/dL had

a 3-fold increase in Type 2 diabetes risk compared to those

with levels less than 83 mg/dL. (Brambilla et al.)

Among young, healthy men, higher fasting plasma glucose

levels within the normal range constitute an independent risk
factor for Type 2 diabetes. This means that as fasting glucose
increases, even if the level is still considered “normal,” it
could indicate a significantly higher risk of developing
diabetes, and this is particularly pronounced if BMI is greater
than 30. (Tirosh, et al.).

Pre-Meal (Baseline) Glucose Goal:

72-90 mg/dL
Why? In a study looking at healthy, young, adults
without diabetes who had normal BMI (mean of
22.6 ± 1.7 kg/m2), the average pre-meal glucose
levels were in the range of 72-90 mg/dL.

Post-Meal Glucose Goal: Less Than

110 mg/dL, With No More Than A 30
mg/dL Increase From Pre-Meal
Levels
Why? In a study looking at healthy adults
without diabetes, researchers found that the
average post-meal glucose peak was 99 ± 10.5
mg/dL after a standardized balanced meal. In
contrast, meals with less fiber and more refined
sugars caused a higher post-meal glucose spike
(up to an average of 133 ± 14 mg/dL) in the same
population. Another study also looking at
healthy, nondiabetic adults found an average
post-meal spike of approximately 122 ± 23
mg/dL. Taking the standard deviation of these
averages into consideration, aiming for a post-
meal glucose level of less than 110 mg/dL with
no more than a 30 mg/dL increase from pre-
meal levels is a reasonable goal to strive for.

Mean 24-Hour Glucose Goal: 79-100

mg/dL
Why? These numbers represent the mean 24-
hour glucose range in a young, very healthy
population. We looked at several different
studies of people without diabetes wearing
CGMs, and this was one of the overall healthiest
populations under normal living conditions.
Therefore we think that 79-100 mg/dL is a safe
and healthy range to orient towards.

Remember, your “optimal” glucose levels are

specific to you, and you should talk with your
healthcare provider about your glucose goals.

How can CGM help you

maintain optimal
glucose levels?
It is not uncommon for your glucose levels to
increase after a meal: you just ate food that may
contain glucose, and now your body is working
on getting it out of the bloodstream and into the
cells. We know that we want to prevent
excessive spiking of glucose levels because
studies show that high post-meal glucose spikes
over 160 mg/dL are associated with higher
cancer rates. Spikes are also associated with
heart disease. Repeated high glucose spikes
after meals contribute to inflammation, blood
vessel damage, increased risk of diabetes, and
weight gain. Additionally, the data shows that
the big spikes and dips in glucose are more
damaging to tissues than elevated but stable
glucose levels. Therefore, you should strive to
keep your glucose levels as steady as possible, at
a low and healthy baseline level, with minimal
variability after meals.

Keeping your glucose levels constant is more

complicated than just following a list of “eat this,
avoid that” foods. Each person has an individual
response to food when it comes to their glucose
levels; studies have shown that two people can
have different changes in their glucose levels
after eating identical foods. The difference can
be quite dramatic. One study found that some
people had equal and opposite post-meal
glucose spikes in response to the same food.

So how do you keep your glucose levels stable?

How do you know when you have a sugar spike
and which foods caused it? That’s where CGM
comes into play. Continuous glucose monitoring
allows you to see your blood glucose levels in
real-time and store that data for future reference;
this makes CGMs uniquely positioned to help
you optimize your diet and lifestyle. Foods affect
each person differently, and it is hard to know
what your blood glucose is doing at any one time
without measuring it. CGMs can give you the
data you need to optimize your health. Choosing
foods and lifestyle habits that consistently keep
average glucose lower and post-meal spikes
lower will improve glucose patterns over time.

Studies have shown that the information

gathered from CGMs can provide more detail
and more potential areas for modification than
the single glucose level that you get with a
glucometer or laboratory blood test. One study
looked at sub-elite athletes and found that 4 out
of 10 study participants spent more than 70% of
the total monitoring time above healthy glucose
levels, and 3 of 10 participants had fasting
glucose in the prediabetic range.

Similar results have been found in other studies:

one reported that 73% of the “healthy”
nondiabetic participants had glucose levels that
were above normal in the range of 140-200
mg/dl at some point during the day.

CGMs can not only give you data on your blood

glucose, but they can help you use the data to
make changes to your diet and exercise routines.
Studies have shown that continuous glucose
monitoring can characterize an individual’s
glucose response to specific foods and, in turn,
predict their responses to other foods. This
technology can allow people to create
personalized meal plans that suit their unique
metabolic needs and improve glucose control.

What are abnormal

glucose levels, and why
do they matter?
Why is it unhealthy for glucose levels to be too
high (hyperglycemia) or too low (hypoglycemia)?

Hyperglycemia refers to elevated blood glucose

levels. This usually occurs because the body
does not appropriately remove glucose from the
blood; this can happen due to many complex
reasons. Elevated glucose levels can damage
blood vessels and nerves over time; this can
then lead to problems in the eyes, kidneys, and
heart, as well as numbness in the hands and
feet. Very high levels can lead to coma and even
death in some cases. People with fasting
glucose levels higher than 100 mg/dl have
impaired glucose tolerance and should speak
with their healthcare provider.

Some people may think that to avoid all these

issues, they should just keep their blood glucose
levels as low as possible. If too high is bad, then
low must be good, right? Not exactly. When
glucose gets too low, it’s called hypoglycemia.
The threshold for hypoglycemia is typically
thought to be when glucose falls below 70
mg/dL. When this happens, the body may
release epinephrine (adrenaline), the “fight or
flight” hormone, which can lead to a fast heart
rate, sweating, anxiety, blurry vision, and
confusion, but also helps the body mobilize
glucose into the blood. If blood glucose levels
stay too low for too long, it can cause seizures,
coma, and in very rare instances, death.

The Nuances Of Low

Glucose
In a recent study, researchers reviewed the
published literature to see if low fasting glucose
levels affected healthy people’s long-term risks
of health problems, like strokes and heart
attacks. They found that healthy non-diabetic
people who had baseline fasting glucose levels
of less than 72 mg/dL had a 56% increase in all-
cause mortality compared to people with normal
fasting blood glucose levels. Also, the risks for
heart attacks and strokes were higher in people
with baseline fasting glucose levels less than 72
mg/dL. This result is likely due to the body
releasing more epinephrine to counteract the
low glucose levels; too much epinephrine for too
long leads to heart problems. Interestingly,
people with low fasting glucose levels of less
than 83 mg/dL but higher than 72 mg/dL did not
have an increased risk of future heart attacks
and strokes.

While there has been an association between

low fasting plasma glucose levels and worse
health outcomes, it is not clear whether transient
dips in glucose levels (less than 70 mg/dL)
during a continuous 24-hour period are
unhealthy for people without diabetes. Part of
the reason that this is unknown is that
continuous glucose monitoring is a relatively
new technology and has been studied more
extensively in people with diabetes than in those
without.

Long-term health outcomes relating to 24-hour

glucose profile metrics are still being evaluated.
In one study looking at people without diabetes
wearing CGMs over a 24-hour period, data
showed that glucose dips below 70 mg/dL
actually occur quite frequently. In fact, 41% of
these healthy people experienced glucose levels
less than 70 mg/dL in a 24-hour period, and the
men’s levels were below 70 mg/dL for 2.7 +/-
6.1% of the 24-hour period (2.1 +/- 4.4 % in
women). Based on this data, healthy people can
reasonably spend an average of 39 minutes with
glucose values less than 70 mg/dL (in men).
Furthermore, considering one standard
deviation higher than the average, it could
reasonably be considered “normal” to spend up
to 126 minutes (8.8% of a 24-hour period) with
CGM-measured glucose values less than 70
mg/dL. The clinical significance of these low
glucose levels is unknown. Still, research
suggests that many healthy people wearing
CGMs spend some amount of time with glucose
levels less than 70 mg/dL.

Research also shows that glucose levels

decrease by an average of 5% during REM sleep
compared to non-REM sleep stages, which may
contribute to periodic dips seen at night in
nondiabetic people. In fact, healthy people who
have glucose dips below 70 mg/dL have twice
as many dips at night as compared to during the
day. Additionally, pressure on the CGM sensor
from laying on it can cause aberrant low values.

Lastly, glucose dips below 70 mg/dL that occur

just after a post-meal glucose spike may indicate
reactive hypoglycemia; which is an exaggerated
insulin response to a high carbohydrate meal,
causing an overshoot in the amount of glucose
that is absorbed out of the bloodstream and into
cells and is not good for health. Again, we don’t
want high highs and low lows; stable glucose
appears to be better for the body. These glucose
dips are typically characterized by symptoms
including fatigue and lack of energy. They
can be avoided by a low-carbohydrate/low-
glycemic eating pattern with reduced post-meal
glucose spikes.

Even though there is no defined low point for

nondiabetic fasting blood glucose levels,
keeping your blood glucose levels above a
minimum threshold of 72 mg/dL may be
beneficial for healthy, non-diabetic people.

Conclusion
What does all this mean? It means that while
there are well-established “normal” ranges of
fasting and post-meal glucose levels, these don’t
give clarity into what glucose trends should be
throughout a 24-hour period. They also don’t
specify what ranges are optimal for the best
health.

Even people with “normal” glucose levels may be

at higher risk of health problems than they
realize because of frequent glucose spikes and
dips or elevated fasting glucose, even if in the
normal range. Your optimal glucose levels
depend on many individual factors, and setting
those ranges should include a discussion with
your healthcare provider.

The studies show that keeping your blood

glucose in the normal range is important, but
also that preventing too many spikes and dips is
key to maintaining your health. A personalized
dietary and lifestyle plan that promotes
metabolic health should also accomplish three
main goals:

1. Minimize post-meal increases in glucose levels

2. Keep glucose levels as stable as possible and minimize

swings in glucose throughout the day

3. Try to keep fasting glucose at the low end of the “normal”

range

Figuring out which diet and lifestyle choices will

allow you to achieve these goals is an iterative
process; no one-size-fits-all plan works for
everyone to keep blood glucose in their optimal
range. Continuous glucose monitoring can help
you establish your optimal diet and lifestyle
choices by serving as a continuous feedback
mechanism, closing the loop between specific
actions and the body’s reaction, and paving the
way for improved current and future health.

Learn More about Your Blood Sugar Levels

Levels, the health tech company behind this
blog, helps people improve their metabolic
health by showing how food and lifestyle impact
your blood sugar using continuous glucose
monitoring (CGM) and an app that offers
personalized guidance and helps you build
healthy habits. Click here to learn more about
Levels.

Want to learn more about your metabolic

health?
Levels, the health tech company behind this
blog, helps people improve their metabolic
health by showing how food and lifestyle impact
your blood sugar, using continuous glucose
monitoring (CGM), along with an app that offers
personalized guidance and helps you build
healthy habits. Click here to learn more about
Levels.

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