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Online Clinical Calculator |
Management of Diabetes during
Ramadan
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Clinical Question:
How should diabetes be managed in patients who choose to fast during
Ramadan?
Bottom Line:
These expert-derived guidelines (there is little study in this area) outline
prudent methods of managing Muslim patients with type 2 diabetes who insist
on fasting during Ramadan. Details are outlined in the synopsis; see the
original paper for managing patients with type 1 diabetes or who are
pregnant.
Reference:
Al-arouj M, Bouguerra R, Buse J, et al. Recommendations for management of
diabetes during Ramadan. Diabetes Care 2005;28:2305-11.
Study Design:
Practice guideline
Funding:
Industry + govt
Setting:
Various (guideline)
Synopsis:
Fasting during the holy month of Ramadan is an obligatory duty for all
healthy adult Muslims. During Ramadan, Muslims will abstain from eating,
drinking, and taking oral medications from predawn until after sunset. Most
people eat one meal after sunset and the other just before dawn. Although
patients with diabetes are exempt from fasting since it might place them at
risk for complications, many patients will insist on fasting. As would be
expected, hypoglycemia, hyperglycemia, diabetic ketoacidosis, and
dehydration and thrombosis are associated with fasting. No research has been
conducted to stratify patients by risk for complications or for providing
guidance for management; these guidelines are based on expert opinion.
Patients at high risk for complications should frequently monitor glucose
levels during the day and must end their fast if hypoglycemia occurs (that
is, less than 60 mg/dL (3.3 mmol/l) at any time, or less than 70 mg/dL (3.9
mmol/L) in the first few hours of a fast). Also, the fast should be broken
if the blood glucose exceeds 300 mg/dL (16.7 mmol/l). Fasting should not
occur on "sick days." Patients taking metformin (Glucophage) should take two
thirds of the daily dose before the sunset meal and the remaining one third
before the predawn meal. No change is required for the glitazones.
Sulfonylureas may be taken with the sunset meal, with the dose adjusted
based on the risk of hypoglycemia. Twice-daily sulfonylureas should be given
as half the normal dose before the predawn meal and the full dose at the
sunset meal. Chlorpropamide should never be used. Repaglinide and
nateglinide may be used before each meal. Insulin can be given once daily
with the sunset meal or individualized and given twice daily, with the
larger dose given with the sunset meal.
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