Diabetes Management in Ramadan

·          During Ramadan, diabetics who chose to fast should be educated about how to adjust their medications and be prepared to break the fast if necessary.

·          During the lunar-based month of Ramadan, Muslims abstain from eating, drinking, smoking, or using oral medications from predawn to sunset.

·          Followers will typically eat just after sunset and again before dawn.

·          In general, fasting is not recommended for people with diabetes. The practice increases the risk for both hypoglycemia from lack of food and hyperglycemia resulting from cutting back too far on medication in attempts to avoid hypoglycemia. Hyperglycemia can also occur if patients overeat after sundown.

·          If the period of fasting is longer and the two meals are eaten close together, this can be tricky.

·          Islamic law does not require fasting when it would create a physical danger.

·          Fasting is especially risky for those with type 1 diabetes, for pregnant women, and for children. However, patients with well-controlled type 1 diabetes who use insulin pumps can often accomplish fasting by adjusting their basal infusion rates and monitoring their blood glucose levels frequently.

·          For patients with type 2 diabetes taking medications other than insulin or sulfonylureas, the risk for hypoglycemia is low. However, because of the prohibition against taking oral medication during daylight hours, patients who usually take metformin 3 times daily should take two-thirds of the dose at the sunset meal and one-third at the predawn meal.

·          Long-acting sulfonylureas should be avoided.

·          Once-daily sulfonylureas should be taken at the sunset meal.

·          For patients taking twice-daily sulfonylureas, the usual dose should be taken at the evening meal and half the usual dose before the predawn meal. One can also skip the predawn dose altogether.

·          The very short-acting insulin secretagogues repaglinide or nateglinide can be taken before each of the meals.

·          No adjustments are needed for thiazolidinediones, alpha-glucosidase inhibitors, incretin-based therapies, or bromocriptine.

·          Basal insulin doses should be reduced by about 30% to 40%. Patients who are on either mixed or intermediate-acting insulins should switch to basal insulin.

·          The usual dose of rapid-acting insulin should be taken before the sunset meal. The predawn dose of rapid-acting insulin can be cut to half or omitted.

·          Frequent monitoring is the key. Patients should be advised to break their fast if the blood sugar drops below 70 mg/dL. If it rises above 250 mg/dL — particularly for patients with type 1 diabetes — they should also break their fast and take insulin.

·          Patients should be cautioned against overeating after breaking the fast.

·          Moderation is the trick. Don't overfill an empty stomach.

·          Patients should be counseled about avoiding dehydration as much as possible.

·          Also adjust BP medicines during Ramadan