Abstract
The aim of this review was to investigate existing guidelines and scientific evidence on determining insulin dosage in people with type 1 and type 2 diabetes, and in particular to check whether the prandial insulin dose should be calculated based on glycemia or the meal composition, including the carbohydrates, protein and fat content in a meal. By exploring the effect of the meal composition on postprandial glycemia we demonstrated that several factors may influence the increase in glycemia after the meal, which creates significant practical difficulties in determining the appropriate prandial insulin dose. Then we reviewed effects of the existing insulin therapy regimens on glycemic control. We demonstrated that in most existing algorithms aimed at calculating prandial insulin doses in type 1 diabetes only carbohydrates are counted, whereas in type 2 diabetes the meal content is often not taken into consideration. We conclude that prandial insulin doses in treatment of people with diabetes should take into account the pre-meal glycemia as well as the size and composition of meals. However, there are still open questions regarding the optimal way to adjust a prandial insulin dose to a meal and the possible benefits for people with type 1 and type 2 diabetes if particular parameters of the meal are taken into account while calculating the prandial insulin dose. The answers to these questions may vary depending on the type of diabetes.
Highlights
In healthy people, fasting plasma glucose rarely reaches 5.5 mmol/L (100 mg/dL) and the highest values after meals do not exceed 7.8 mmol/L (140 mg/dL), and quickly return to the starting level [1].Hyperglycemia defines diabetes, and glycemic control plays an important role in the treatment of diabetes
Foods with a low glycemic index (GI) cause a smaller increase in the glucose level, reducing the peak of glycemia, but at the same time it was demonstrated that such foods increase the risk of hypoglycemia after the meal in people with type 1 diabetes if taken with inadequate doses of insulin [16]
It seems reasonable to conclude that in the insulin treatment of people with diabetes prandial doses of insulin should take into account the result of pre-meal glycemia as well as the composition and size of meals
Summary
In healthy people, fasting plasma glucose rarely reaches 5.5 mmol/L (100 mg/dL) and the highest values after meals do not exceed 7.8 mmol/L (140 mg/dL), and quickly return to the starting level [1]. Foods with a low GI cause a smaller increase in the glucose level, reducing the peak of glycemia, but at the same time it was demonstrated that such foods increase the risk of hypoglycemia after the meal in people with type 1 diabetes if taken with inadequate doses of insulin [16]. Taking carbohydrates at the beginning of a meal shortens the period of suppression of ghrelin, which may result in shortening the period of feeling satiety, speeding up the meal, and leading to weight gain All these data indicate that a few factors may influence the increase in glycemia after the meal, which creates significant practical difficulties in determining the appropriate dose of insulin to compensate for food intake in people with diabetes
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