Recommendations for Management of Diabetes During Ramadan

Dr. Faisal Al Haddad

Consultant of Family Medicine & Occupational Health

PSMMC

REGULATION OF BLOOD GLUCOSE LEVEL

Pre-Ramadan Assessment

1 .Medical Assessment

2 .Counseling Risks of fasting

Nutrition Physical activity Breaking the fast

Self-care Changes in medications regimen

الرحيم الرحمن الله بسم

كتب ) كما الصيام عليكم كتب امنوا الذين يأيهاتتقون لعلكم قبلكم من الذين أياما على

سفر على أو مريضا منكم كان فمن معدوداتفدية يطيقونه الذين وعلى أخر أيام من فعدة

له خير فهو خيرا تطوع فمن مسكين طعامتعلمون كنتم ان لكم خيرا تصوموا )وان

العظيم الله صدق

RISKS ASSOCIATED WITH FASTING

1 .Hypoglycemia

2 .Hyperglycemia

3 .Dehydration

NUTRITION

Ingestion of large amounts of foods at Iftar meal, should be avoided.

Ingestion of foods containing “complex” carbohydrates advisable at Suhur meal, while foods with more simple carbohydrates more appropriate at Iftar meal.

Fluid intake should be increased during nonfasting hours.

Suhur meal should be taken as late as possible before the start of the daily fast.

PHYSICAL ACTIVITY

The exercise program should be modified in its intensity and timing to avoid hypoglycemic episodes.

Tarawaih prayer should be considered a part of the daily exercise program.

BREAKING THE FAST

1. Blood glucose < 60 mg/dl.

2. Blood glucose < 70 mg/dl in the first few hours after the start of the fast .

3. Blood glucose > 300 mg/dl .

4. Acute illness.

SELF CARE

Frequent blood glucose monitoring.

Management of acute complications.

Changes in their medications.

ORAL HYPOGLYCEMIC AGENTS

Metformin decrease insulin resistance

Glitazones

Sulfonylureas increase insulin secretion

Meglitinides

ORAL HYPOGLYCEMIC AGENTS

●Metformin: 2/3 of the daily dose should be given before Iftar

meal, and the other third given before Suhur meal.

Glitazones : no change.

Meglitinides : short-acting Meglitinides can be taken twice daily before Iftar and Suhur meals .

ORAL HYPOGLYCEMIC AGENTS

●Sulfonylureas long acting agents (chlorpropamide( is absolutely

contraindicated.

Newer sulfonylureas (gliclazide MR( associated with lower risk of hypoglycemia.

If the usual dose is once a day, the dose should be given before the Iftar meal.

if twice a day, give the full dose at Iftar meal and half the dose at Suhur meal.

TYPES OF INSULIN

TYPE NAME ONSET PEAKDURATION

Rapid Acting(Humalog( Lispro 5 - 15 min30 - 90 min3 - 5 hours

Short ActingRegular - ½one hour2-4 hours6-8 hours

IntermediateNPH

Lente

1-3 hours6-10 hours10-16 hours

Long ActingUltralente

(Lantus( Glargine

4-6 hours

1-2 hours

18 hours

No peak

24-36 hours

24-36 hours

INSULIN

Intermediate (NPH( + Short (regular( premeals.

Long-acting (ultralente( + Short (regular( premeals.

Long-acting analog (glargine( OD , Short (regular( premeals.

Rapid-acting insulin (lispro( can be used instead of short-acting insulin.