Insulin Dosing for Blood Glucose 274 mg/dL with Carb Ratio 1:10
Immediate Correction Dose Calculation
For a blood glucose of 274 mg/dL with a target of 120 mg/dL, you need approximately 3-5 units of rapid-acting insulin as a correction dose, in addition to any carbohydrate coverage needed for the meal. 1
The correction dose is calculated using your insulin sensitivity factor (ISF). With a carb ratio of 1:10, your ISF is approximately 30-50 mg/dL per unit of insulin (using the formula 1500 ÷ TDD) 2, 3. This means:
- Glucose difference: 274 - 120 = 154 mg/dL above target
- Correction dose: 154 ÷ 30-50 = approximately 3-5 units of rapid-acting insulin 1, 2
Total Mealtime Insulin Dose
If you are eating a meal, your total insulin dose = carbohydrate coverage + correction dose 1, 2:
- For a 60-gram carbohydrate meal with 1:10 ratio = 6 units for carbs
- Plus 3-5 units for correction = 9-11 units total 1
Critical Timing Considerations
- Administer rapid-acting insulin (lispro, aspart, or glulisine) 0-15 minutes before eating to effectively manage postprandial glucose 4, 5
- If using regular insulin instead, give it 30-45 minutes before the meal 1
- Never give rapid-acting insulin at bedtime for correction alone, as this significantly increases nocturnal hypoglycemia risk 1, 6
When Blood Glucose Remains This High
If your blood glucose is persistently ≥250-300 mg/dL, this signals inadequate basal insulin coverage, not just a correction issue 1, 7. You should:
- Increase your basal insulin by 4 units every 3 days until fasting glucose consistently reaches 80-130 mg/dL 1
- Consider adding or intensifying prandial insulin if basal insulin alone is insufficient after 3-6 months 1
- When basal insulin exceeds 0.5 units/kg/day without achieving targets, adding prandial coverage becomes more appropriate than continuing to escalate basal insulin 1
Monitoring Requirements
- Check blood glucose 2-4 hours after correction to assess effectiveness and watch for hypoglycemia 7
- If correction doses consistently fail to bring glucose into target range, your ISF needs adjustment 1
- Daily fasting blood glucose monitoring is essential during any insulin titration phase 1
Common Pitfalls to Avoid
- Do not "stack" insulin by giving another correction dose within 3-5 hours of the previous rapid-acting dose, as insulin from the first dose is still active 1, 2
- Never rely solely on correction insulin without optimizing your basal insulin first—sliding scale alone is ineffective and dangerous 1, 6
- If blood glucose is frequently this high, your basal insulin regimen needs immediate adjustment, not just repeated correction doses 1, 7
- For blood glucose ≥300-350 mg/dL with symptoms, evaluate for diabetic ketoacidosis before giving subcutaneous insulin 6, 7