Table 2

Summary of systematic review: studies evaluating prandial insulin dosing equations and requirements for high-fat meals with or without protein

MethodaLimitation
Two studies (28,33) calculated additional insulin for fat and protein using a complex dosing equation with FPUs (35) and the subject’s CIR.High rate of clinically significant postprandial hypoglycemia compared with carbohydrate counting.
One study (29) used a predetermined value of 50% of the CIR to calculate fat-to-insulin and protein-to-insulin ratios and added the additional insulin to extended bolus.Suboptimal postprandial glucose control.
Two studies (22,23) used the FII to calculate additional insulin for high-fat and/or -protein meals. Both studies reported significantly improved glycemia in the 3-h postprandial period.Because of the short postprandial monitoring period, may have failed to detect delayed impact of fat and protein on glucose concentrations.
One study (19) used closed-loop control to determine additional insulin required to maintain postprandial glycemic control after a high-fat meal; definitively established that high-fat meals need more insulin coverage than lower-fat meals with identical carbohydrate content.Findings need to be translated into a dosing equation for use in clinical practice.
  • See Supplementary Table 2 for details.

  • aMethod used to calculate the additional insulin and the amount given varied across studies.