What Are Blood Sugar Targets?

Before you can recognize "too high" or "too low," you need to know what "just right" looks like. The ADA Standards of Care 2026 recommend specific targets for people with T1D. Think of these as your dashboard — they tell you how your blood sugar management is going overall.

The Key Numbers

Beyond the Basics — What These Metrics Tell You

Time in Range (TIR) is considered the gold standard metric because it captures the full picture. A high TIR with a low CV means you're spending most of your time in range AND your blood sugar is stable — that's the sweet spot.

CV (Coefficient of Variation) is like a "smoothness" score. Even if your average blood sugar looks great, a CV above 36% means you're swinging between highs and lows too often — like a rollercoaster that averages out to a flat line but is anything but smooth.

What Is Hyperglycemia?

Hyperglycemia means your blood sugar is above 180 mg/dL (10.0 mmol/L). It's one of the most common daily challenges in T1D. The key is understanding WHY it happens so you can respond effectively.

Common Causes of High Blood Sugar

Insulin-Related:

• Missed or late insulin dose
• Not enough insulin for the carbs you ate
• Insulin that has gone bad (heat exposure, expired)
• Infusion site issues (pump users)

Food & Lifestyle:

• Eating more carbs than expected
• High-fat meals that cause delayed rises (the "pizza effect")
• Stress — both physical and emotional
• Illness or infection (even a cold can spike your blood sugar)

Hormonal & Other:

• Dawn phenomenon (early morning hormone surge)
• Hormonal changes (menstrual cycle, growth spurts)
• Certain medications (steroids, for example)
• Rebound highs after a low (Somogyi effect)

Scenario: Sarah's Stressful Morning

Sarah, 28, has had T1D for six years. She wakes up with a blood sugar of 95 mg/dL — perfect. She eats her usual breakfast (40g carbs) and boluses correctly. But today is her big work presentation. By 10 AM, her CGM reads 245 mg/dL with an upward arrow, even though she ate the same breakfast as yesterday.

What happened? Stress hormones (cortisol and adrenaline) triggered her liver to release extra glucose, AND made her cells more resistant to insulin. The same dose that worked yesterday wasn't enough today. Sarah takes a small correction bolus, drinks water, and does a quick breathing exercise before her presentation.

Recognizing the Symptoms

Early Symptoms (you might not even notice these at first):

• Increased thirst (polydipsia)
• Frequent urination (polyuria)
• Fatigue or feeling "foggy"
• Blurred vision
• Headache

Later Symptoms (if blood sugar stays high):

• Nausea or vomiting
• Fruity-smelling breath (a sign of ketones forming)
• Difficulty concentrating
• Shortness of breath
• Abdominal pain

Your Hyperglycemia Checklist

When your blood sugar is high, run through this mental checklist:

• Confirm — Is the reading accurate? (Wash hands, recheck if finger stick; check CGM calibration)
• Insulin check — Did I take my dose? Is my pump site working? Is my insulin still good?
• Carb check — Did I underestimate carbs at my last meal?
• Context check — Am I stressed, sick, or did I just exercise intensely?
• Correct — Take correction insulin as prescribed by your healthcare team
• Hydrate — Drink water to help flush excess glucose
• Ketones — Check for ketones if blood sugar is above 250 mg/dL (13.9 mmol/L) and not coming down despite correction
• Monitor — Recheck in 1-2 hours to make sure it's coming down