4. بسم ال الرحمن الرحيم
)يأيها الذين امنوا كتب عليكم الصيام كما كتب على الذين
من قبلكم لعلكم تتقون أياما معدودات فمن كان منكم
مريضا أو على سفر فعدة من أيام أخر وعلى الذين يطيقونه
فدية طعام مسكين فمن تطوع خيرا فهو خير له وان
تصوموا خيرا لكم ان كنتم تعلمون )
صدق ال العظيم
6. 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.
7. 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.
8. 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.
9. SELF CARE
Frequent blood glucose monitoring.
Management of acute complications.
Changes in their medications.
13. ORAL HYPOGLYCEMIC AGENTS
:Metformin●
of the daily dose should be given before Iftar 2/3
.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 .
14. 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.
16. TYPES OF INSULIN
TYPE
NAME
ONSET
PEAK
DURATION
Rapid Acting
Humalog) Lispro)
min 15 - 5
min 90 - 30
hours 5 - 3
Short Acting
Regular
one hour½ -
hours 2-4
hours 6-8
Intermediate
NPH
Lente
hours 1-3
hours 6-10
hours 10-16
Long Acting
Ultralente
Lantus) Glargine)
hours 4-6
hours 1-2
hours 18
No peak
hours 24-36
hours 24-36
17. 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.