My blood glucose is 74 mg/dL two hours after a meal and my insulin‑to‑carbohydrate ratio is 1 unit per 10 g carbohydrate; should I give a correction or meal‑time bolus insulin?

Blood Glucose of 74 mg/dL Two Hours After a Meal: No Insulin Correction Needed

Do not give any correction or meal-time bolus insulin for a blood glucose of 74 mg/dL two hours after eating. This value is within the normal physiological range and does not require insulin intervention.

Why No Insulin Is Needed

• A blood glucose of 74 mg/dL is entirely normal two hours after a meal, falling well within the target postprandial range of <180 mg/dL recommended for people with diabetes 1.
• In healthy individuals without diabetes, continuous glucose monitoring shows mean peak postprandial glucose levels around 110 mg/dL, making 74 mg/dL a completely physiologic value 2.
• The American Diabetes Association defines the hypoglycemia alert threshold as <70 mg/dL 1; your glucose of 74 mg/dL is above this threshold and does not constitute hypoglycemia 1.

Understanding Your Insulin-to-Carbohydrate Ratio

• Your ratio of 1 unit per 10 grams of carbohydrate is a standard starting point for carbohydrate counting 1, 3.
• This ratio appears to be working appropriately, as your postprandial glucose is in the normal range two hours after eating 1, 4.
• The fact that your glucose is 74 mg/dL suggests your mealtime insulin dose was well-matched to your carbohydrate intake 1, 4.

What You Should Do Instead

Immediate Actions

• No treatment is required for a glucose of 74 mg/dL 1.
• Continue your normal activities without additional carbohydrate intake unless you develop symptoms of hypoglycemia 1.
• If you plan to exercise within the next 1–2 hours, consider a small carbohydrate snack (10–15 g) to prevent hypoglycemia during activity 4.

Monitoring

• If you experience symptoms such as shakiness, sweating, confusion, or rapid heartbeat, recheck your glucose immediately 1.
• Treat only if glucose falls below 70 mg/dL with approximately 15 grams of fast-acting carbohydrate (e.g., 4 glucose tablets or 4 oz juice), then recheck in 15 minutes 1, 3.

Critical Pitfalls to Avoid

• Never give correction insulin for a glucose of 74 mg/dL—this would cause hypoglycemia and is dangerous 1, 3.
• Do not use protein-rich foods (such as nuts) to treat or prevent hypoglycemia, as protein can stimulate insulin secretion in type 2 diabetes and may worsen the situation 1.
• Avoid "stacking" insulin doses by giving correction insulin within 3–4 hours of your last mealtime dose, as the previous insulin may still be active 3.
• Do not adjust your insulin-to-carbohydrate ratio based on a single postprandial glucose reading; changes should be made only after observing consistent patterns over 3 days 1, 3.

When to Adjust Your Insulin Regimen

• If your 2-hour postprandial glucose is consistently <70 mg/dL after meals, reduce your mealtime insulin dose by 10–20% (e.g., from 1:10 to 1:12 ratio) 1, 3.
• If postprandial glucose is consistently >180 mg/dL, increase your mealtime insulin by 1–2 units or 10–15% every 3 days based on 2-hour postprandial readings 1, 3.
• The target 2-hour postprandial glucose is <180 mg/dL for most adults with diabetes 1, 4.

Special Considerations

• Postprandial glucose naturally peaks 30–60 minutes after eating and then declines; a value of 74 mg/dL at 2 hours indicates your glucose has returned to near-baseline levels 2.
• If you have impaired awareness of hypoglycemia, be extra vigilant about avoiding unnecessary insulin corrections above 70 mg/dL, as repeated hypoglycemia can further blunt your body's warning symptoms 3.
• For patients with type 1 diabetes or insulin-dependent type 2 diabetes, maintaining glucose above 70 mg/dL is essential to prevent dangerous hypoglycemic episodes 1, 3.