Management of Type 2 diabetes in Ramadan: Low-ratio premix insulin working group practical advice

Abstract

The challenge of insulin use during Ramadan could be minimized, if people with diabetes are metabolically stable and are provided with structured education for at least 2–3 months pre-Ramadan. Although, American diabetes association (ADA) recommendations 2010 and South Asian Consensus Guideline 2012 deal with management of diabetes in Ramadan and changes in insulin dosage, no specific guidance on widely prescribed low-ratio premix insulin is currently available. Hence, the working group for insulin therapy in Ramadan, after collective analysis, evaluation, and opinion from clinical practice, have formulated a practical advice to empower physicians with pre-Ramadan preparation, dose adjustment, and treatment algorithm for self-titration of low-ratio premix insulin.

Diabetes and Ramadan: Practical guidelines

“…2). Most importantly, glucose levels should be checked at any time when symptoms of hypoglycaemia are recognised [23]. All patients should comprehend the dangers of low and high blood glucose levels, know when to break the fast, and must not fast if they are unwell [8].…”

“…2). Patients should break the fast if blood glucose is <70 mg/dL (3.9 mmol/L) or >300 mg/dL (16.7 mmol/L) and should not fast if they feel unwell [23]. Low risk patients also need to perform SMBG at the following times: pre-suhoor, midday, pre-iftar and whenever symptoms of hypoglycaemia or acute illness occur [23].…”

Recommendations for management of diabetes during Ramadan: update 2015

“…Table 2 lists recommendations for insulin self-titration during the Ramadan period. The ‘Low-Ratio Premix Insulin Working Group’ recently reported a practical outline on how to adjust insulin during the fasting period, based on premeal blood glucose levels and the history of hypoglycemia 23. This group also recommended a trial fast for three consecutive days before Ramadan to help in detecting hypoglycemia risk and for guiding the self-titration of premix insulin dosage.…”

The characteristics and pattern of care for the type 2 diabetes mellitus population in the MENA region during Ramadan: An international prospective study (DAR-MENA T2DM)

“…The EPIDIAR study reported that approximately 50% of participants with diabetes experienced a change in lifestyle, with the proportion of participants with T2DM experiencing a change ranging from 25.2% to 54.4% for oral antidiabetic drug (OAD), insulin dose, weight, physical activity, sugar intake, food intake, fluid intake, and sleep duration [4]. Ramadan-focused education can enable individuals to adjust their lifestyle during Ramadan, minimize the risk of hypoglycemic events and weight gain, and be tempered to the local practices and seasonal time of year when Ramadan occurs [7,10,[12][13][14][15][16]. A recent prospective study found that pre-Ramadan education reduced acute complications, including hypoglycemia risk and low-density lipoprotein (LDL) cholesterol and improved high-density lipoprotein (HDL) cholesterol [17].…”