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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
Medical Assessment. 1
Counseling. 2
Risks of fasting
Nutrition
Physical activity
Breaking the fast
Self-care
Changes in medications regimen
‫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
RISKS ASSOCIATED WITH FASTING

Hypoglycemia. 1
Hyperglycemia. 2
Dehydration. 3
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.
Diabetes in ramadan
Diabetes in ramadan
ORAL HYPOGLYCEMIC AGENTS

Metformin
Glitazones

decrease insulin resistance

Sulfonylureas
Meglitinides

increase insulin secretion
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 .
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.
Diabetes in ramadan
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
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.
Diabetes in ramadan

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Diabetes in ramadan

  • 1. Recommendations for Management of Diabetes During Ramadan Dr. Faisal Al Haddad Consultant of Family Medicine & Occupational Health PSMMC
  • 2. REGULATION OF BLOOD GLUCOSE LEVEL
  • 3. Pre-Ramadan Assessment Medical Assessment. 1 Counseling. 2 Risks of fasting Nutrition Physical activity Breaking the fast Self-care Changes in medications regimen
  • 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
  • 5. RISKS ASSOCIATED WITH FASTING Hypoglycemia. 1 Hyperglycemia. 2 Dehydration. 3
  • 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.
  • 12. ORAL HYPOGLYCEMIC AGENTS Metformin Glitazones decrease insulin resistance Sulfonylureas Meglitinides increase insulin secretion
  • 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.