New insights on glucose homoeostasis during Ramadan

Monnier, L.; Bonnet, Fabrice; Colette, C

doi:10.1016/j.diabet.2014.11.005

Cited by 5 publications

(3 citation statements)

References 21 publications

(37 reference statements)

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“…Observation done on diabetic patients during Ramadan fasting showed the carbohydrate loads for both sahur and iftar largely exceed the total body glucose uptake capabilities (2 mg/kg/min) for healthy individuals. 18 Specifically in Malaysia, there are increased number of "iftar buffet" in hotels and "bazaar" in streets providing variety of food and drinks after long hours of fasting. 19 The implications of these two phenomena which create an abundant food environment in addition to late night snack (moreh) may lead to binge eating and overeating, worsening the glycaemic control in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan

Yahaya

Ibrahim

Othman

et al. 2018

imjm

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Introduction: Pregnant women are among those who are exempted from Ramadan fasting. Despite that, many pregnant women had chosen to fast despite understanding the risk of complications especially hypoglycaemia. In Hospital USM (HUSM), an insulin regime for pregnant women who wish to fast was designed based on expert opinion of obstetricians, but its safety and efficacy are yet to be determined. Objective: To determine the safety and efficacy of the formulated insulin regime using subcutaneous Actrapid® and Insulatard® amongst pregnant women with diabetes who fast in Ramadan. Methodology: Pregnant patients with diabetes on insulin who wish to fast during Ramadan were invited to participate in the study. The total daily dose of insulin requirement prior to Ramadan was divided 3 parts; 2/3 for iftar (sunset meal) and 1/3 for sahur (pre-dawn meal). For each timing, 2/3 of the calculated dose was given as short-acting insulin Actrapid® and remaining 1/3 as intermediate-acting insulin Insulatard®. Three patients were monitored in the ward while fasting for two days. Blood glucose checked eight times a day. Following that, eight patients were followed up during Ramadan fasting with this regime. Weekly blood sugar profile (BSP) was taken and glycaemic control evaluated. Results: All patients were able to fast without any hypoglycaemic episode, both during in-patient study and during out-patient Ramadan fasting. Mean daily blood glucose per day for in-patient monitoring was 7.3 mmol/l with the lowest being 4.56 mmol/l in the afternoon. During Ramadan fasting, average glucose level was higher (6.79 mmol/l) compared to prior to Ramadan value (5.67 mmol/l) (p> 0.05). However, improvement of glycaemic control was observed towards end of Ramadan. Conclusion: Pregnant women with diabetes treated with insulin can fast safely during Ramadan using the suggested insulin regime with improvement of glycaemic control observed at the end of Ramadan.

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Section: Discussionmentioning

confidence: 99%

Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan

Yahaya

Ibrahim

Othman

et al. 2018

imjm

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“…Le mieux est de titrer la dose de ces médicaments à un niveau qui permet d'éviter les hypoglycémies en utilisant la glycémie de fin d'après midi, avant le repas de rupture du jeûne. En effet, cette glycémie est la plus basse de la journée chez tous les diabétiques de type 2 [37] et plus particulièrement chez ceux qui suivent le Ramadan (figures 1 et 3) [12,20]. Dans ces conditions, la dose de sulfonylurée ou de glinide devrait être ajustée de telle manière que ce nadir glycémique de fin d'après midi, dit « de sécurité », reste supérieur à 0,70-0,80 g/L.…”

Section: Cours Du Ramadanunclassified

“…Iftar) chez les diabétiques et le maintien d'une glycémie élevée pendant la nuit[12,20] soulèvent le problème des apports nutritionnels chez les diabétiques pendant le Ramadan. Rappelons brièvement que la réalimentation entre le coucher et le lever du soleil au cours du Ramadan est jalonnée par 2 repas[24].Le premier, dit de rupture du jeûne (Iftar), suit le coucher du soleil.…”

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Ramadan et diabète : est-ce un problème ? Considérations pratiques et apport de la mesure continue de la glycémie

Monnier

Azrak²,

Rochd³

et al. 2015

Médecine des Maladies Métaboliques

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National audienceThe holy month of Ramadan is characterized by abstinence from eating and drinking from dawn to sunset. This dietary practice entails profound changes in life style habits. The sunset meal (Iftar) that breaks the fasting state is usually followed by exaggerated surges in blood glucose, which can further result in overnight sustained hyperglycemia in case of nocturnal overfeeding. The latter is usually related to additional food intakes that can be provided as either a dinner taken 2 or 3 hours after the sunset meal or intermittent repeated snacks, and sometimes as a combination of both of them. Throughout the nocturnal period, the cumulative consumption of carbohydrates including the predawn meal (Sohour) can reach a level as high as 500 grams. In such situations, it is not surprising that the glycemic control of persons with diabetes, especially of those treated with insulin, shows marked disturbances during Ramadan. In many patients, the exaggerated loads in calories and carbohydrates result in body weight gain. Analyses of marketed food supplies confirm this overconsumption and thus this overfeeding. Consequently, both dietary measures and pharmacological glucose-lowering treatments are not easy to handle during Ramadan. The most appropriate attitude would be to convincing persons with diabetes for being exempted from religious fasting when the following conditions are not fulfilled: compliance to a nutritional program and acceptance/understanding of a structured and personalized therapeutic regimen. Assignment to a tight self-monitoring of blood glucose should be recommended at least in those requiring multiple daily injections of insulin. Patients who do not comply to such requirements are at risk for acute adverse events (severe hyperglycemia and/or hypoglycemia) during the Ramadan period. In addition, there arises the question as to whether a 1-month excess in glucose exposure every year for several decades has or not the potency to exert a deleterious « legacy impact » on the long-term development and/or progression of chronic diabetic complications.Le mois religieux du Ramadan est caractérisé par l’abstention de toute consommation d’aliments ou de liquides du lever au coucher du soleil. Cette pratique modifie de manière considérable les habitudes alimentaires. Le repas de rupture du jeûne (Iftar), souvent riche en glucides rapides, entraîne, chez les patients diabétiques, une brusque montée de la glycémie, qui peut conduire à une hyperglycémie soutenue et chronique sur l’ensemble de la période nocturne si le repas de rupture du jeûne est suivi soit par un dîner consommé 2 à 3 heures après, soit par plusieurs collations, soit par les deux à la fois. Si l’on inclut le repas pris avant l’aube (Sohour), la consommation cumulée de glucides sur la période nocturne peut atteindre les 500 grammes. Dans ces conditions, il n’est pas étonnant que l’équilibre glycémique des patients diabétiques, en particulier de ceux qui sont insulino-traités, soit profondément perturbé pendant le Ramadan. Chez de n...

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Ramadan and diabetes: What we see, learn and understand from continuous glucose monitoring

Monnier

Azrak

Lessan

et al. 2015

Diabetes & Metabolism

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New insights on glucose homoeostasis during Ramadan

Cited by 5 publications

References 21 publications

Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan

Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan

Ramadan et diabète : est-ce un problème ? Considérations pratiques et apport de la mesure continue de la glycémie

Ramadan and diabetes: What we see, learn and understand from continuous glucose monitoring

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