Background: Despite efforts to control hyperglycemia, diabetes management is still challenging.
This may be due to focusing on reducing hyperglycemia and neglecting the importance of hyperinsulinemia;
while insulin resistance and resultant hyperinsulinemia preceded diabetes onset and
may contribute to disease pathogenesis.
Objective: The present narrative review attempts to provide a new insight into the management of diabetes
by exploring different aspects of glycemic index and dietary insulin index.
Results: The current data available on this topic is limited and heterogeneous. Conventional diet therapy
for diabetes management is based on reducing postprandial glycemia through carbohydrate counting,
choosing foods with low-glycemic index and low-glycemic load. Since these indicators are only
reliant on the carbohydrate content of foods and do not consider the effects of protein and fat on the
stimulation of insulin secretion, they cannot provide a comprehensive approach to determine the insulin
Conclusion: Selecting foods based on carbohydrate counting, glycemic index or glycemic load are
common guides to control glycemia in diabetic patients, but neglect the insulin response, thus leading
to failure in diabetes management. Therefore, paying attention to insulinemic response along with glycemic
response seems to be more effective in managing diabetes.