Bolus Estimation--Rethinking the Effect of Meal Fat Content

Diabetes Technol Ther. 2015 Dec;17(12):860-6. doi: 10.1089/dia.2015.0118. Epub 2015 Aug 13.


Background: Traditionally, insulin bolus calculations for managing postprandial glucose levels in individuals with type 1 diabetes rely solely on the carbohydrate content of a meal. However, recent studies have reported that other macronutrients in a meal can alter the insulin required for good postprandial control. Specifically, studies have shown that high-fat (HF) meals require more insulin than low-fat (LF) meals with identical carbohydrate content. Our objective was to assess the mechanisms underlying the higher insulin requirement observed in one of these studies.

Materials and methods: We used a combination of previously validated metabolic models to fit data from a study comparing HF and LF dinners with identical carbohydrate content in seven subjects with type 1 diabetes. For each subject and dinner type, we estimated the model parameters representing the time of peak meal-glucose appearance (τ(m)), insulin sensitivity (S(I)), the net hepatic glucose balance, and the glucose effect at zero insulin in four time windows (dinner, early night, late night, and breakfast) and assessed the differences in model parameters via paired Wilcoxon signed-rank tests.

Results: During the HF meal, the τ(m) was significantly delayed (mean and standard error [SE]: 102 [14] min vs. 71 [4] min; P = 0.02), and S(I) was significantly lower (7.25 × 10(-4) [1.29 × 10(-4)] mL/μU/min vs. 8.72 × 10(-4) [1.08 × 10(-4)] mL/μU/min; P = 0.02).

Conclusions: In addition to considering the putative delay in gastric emptying associated with HF meals, we suggest that clinicians reviewing patient records consider that the fat content of these meals may alter S(I).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Combined Modality Therapy
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diet therapy
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / metabolism
  • Diet, Diabetic*
  • Diet, Fat-Restricted*
  • Diet, High-Fat*
  • Dietary Fats / administration & dosage*
  • Dietary Fats / metabolism
  • Digestion
  • Drug Dosage Calculations
  • Female
  • Gastric Emptying
  • Humans
  • Hyperglycemia / prevention & control
  • Hypoglycemia / chemically induced
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / therapeutic use
  • Insulin / administration & dosage*
  • Insulin / therapeutic use
  • Insulin Resistance
  • Male
  • Matched-Pair Analysis
  • Meals
  • Middle Aged


  • Dietary Fats
  • Hypoglycemic Agents
  • Insulin