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Management of Diabetes During Ramadan Amir Ziaee , M.D.

Management of Diabetes During Ramadan Amir Ziaee , M.D. Professor of Internal Medicine & Endocrinology. يَا أَيُّهَا الَّذِينَ آمَنُواْ كُتِبَ عَلَيْكُمُ الصِّيَامُ كَمَا كُتِبَ عَلَى الَّذِينَ مِن قَبْلِكُمْ لَعَلَّكُمْ تَتَّقُونَ. The goal of fasting is to develop self-restraint.

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Management of Diabetes During Ramadan Amir Ziaee , M.D.

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  1. Management of Diabetes During Ramadan Amir Ziaee, M.D. Professor of Internal Medicine & Endocrinology

  2. يَا أَيُّهَا الَّذِينَ آمَنُواْ كُتِبَ عَلَيْكُمُ الصِّيَامُ كَمَا كُتِبَ عَلَى الَّذِينَ مِن قَبْلِكُمْ لَعَلَّكُمْ تَتَّقُونَ The goal of fasting is to developself-restraint. Holy Quran states: “O you who believe! Fasting is prescribed to you as it was prescribed to those before you, so that you may develop Taqwa(self-restraint) ” [2:183] Example: God says about Mary in the Qur’an that she said: “Verily!, I have vowed a fast to the Most Beneficent…[Maryam 19:26]. What is Taqwa? Taqwa is an Arabic word. It is the state of heart that motivates virtuous conduct and prevents evil action. leads to Love of God + Fear of God Taqwa (Self-restraint) Taqwa is the ability to safe-guard.

  3. Benefits of Fasting in Islam : How character-building is achieved… God-fearing nature Afterlife Accountability Patience Self-control Fasting Taqwa (Self-restraint) Self-discipline Responsibility Obedience Purification of soul

  4. Changes in Carbohydrates Metabolism During Fasting of Ramadan

  5. The effect of Ramadan fasting on metabolism and different organs in healthy individuals

  6. How many people with diabetes fast during Ramadan? Salti et al. Diabetes Care 2004; 27: 2306

  7. Major risks associated with fastingin patients with diabetes

  8. Very high risk Severe hypoglycemia within the last 3 months prior to RamadanPatient with a history of recurrent hypoglycemia Patients with hypoglycemia unawarenessPatients with sustained poor glycemic controlKetoacidosis within the last 3 months prior to RamadanType 1 diabetesAcute illness Hyperosmolar hyperglycemic coma within the previous 3 monthsPatients who perform intense physical labor PregnancyPatients on chronic dialysis Categories of risks in patients with type 1 or type 2 diabetes who fast during Ramadan Al-Arouj et al. Diabetes Care 2010; 33: 1895

  9. Categories of risks in patients with type 1 or type 2 diabetes who fast during Ramadan Al-Arouj et al. Diabetes Care 2010; 33: 1895

  10. Management of Patients with Type 2 Diabetes on Insulin Use of a rapid acting insulin analog instead of regular human insulin before meals in patients with type 2 diabetes who fast during Ramadan is associated with less hypoglycemia and smaller postprandial glucose excursions.

  11. Recommended changes to insulin regimen in patients with type 2 diabetes who fast during Ramadan

  12. If patient is on premix insulin therapy  Use the usual morning dose at the sunset meal (Iftar) and half the usual evening dose at predawn (sahur), e.g., 70/30 premixed insulin 30 units in the morning and 20 units in the evening before Ramadan (BHI 30 or BIAsp 30), during Ramadan recommended dose will be 30 units in evening and 10 units at sahur; also consider changing to basal plus bolus.

  13. If on Basal Bolus insulin therapy ■Bolus portionMorning dose: Transfer full dose at iftaar. Evening dose: Transfer ½ dose at sahur. Lunch dose: If patient takes dinner, transfer the full dose at dinner.

  14. If on Basal Bolus insulin therapy Basal portionIf patient is on NPH: 50% dose at sahur. If patient is on basal analog: Same dose at bed time.

  15. Blood Glucose Monitoring During Ramadan Adjust insulin dose at 3 days' interval - Pre-iftaar: adjust basal insulin dose- 2 hours post-iftaar: adjust iftaar bolus insulin dose- 2 hours postdinner: adjust dinner bolus insulindose- 2 hours post-sahur: adjust sahur bolus insulin dose.

  16. Blood Glucose Monitoring During Ramadan If blood glucose is noted to be low, fasting must be broken. If blood glucose > 300 mg/dl or 16.66 mmol/L, ketones in urine should be checked. 

  17. Conclusion It is possible for people with diabetes to fast safely during Ramadan, but requires careful planning in order to avoid problems that could be serious and have long-term effects. The choice of insulin therapy is decided by the previous therapy that the patient is taking and also the blood glucose profiles.

  18. Conclusion The major objective of insulin therapy during Ramadan is to provide adequate insulin to prevent the post meal hyperglycemia and also prevent hypoglycemia during the period of fast. With the use of analogues these objectives may be met more easily.

  19. Thanks for your attention

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