DIABETES MELLITUS

and
RAMADHAN FASTING

Suharno
 Diabetic patients are at risk of harmful
consequences due to the changes in pattern
and amount of food and fluid intake during
Ramadan.
The harmful consequences associated with
fasting are
1.Hypoglycemia,
2.Hyperglycemia,
3.Ketoacidosis,
4.Dehydration and thrombosis
ADA workgroup has categories risk in patients with diabetes
who fast during Ramadan as follows

Very high risk group

1. Severe hypoglycemia within the last 3 months prior to Ramadan
2. Patient with history of recurrent hypoglycemia
3. Patient with hypoglycemia unawareness
4. Patient with sustained poor glycemic control
5. Ketosis within the last 3 months prior to Ramadan
6. Type 1 DM
7. Acute illness
8. Hyperosmolar hyperglycemic coma within the last 3 months.
9. Patients who performs intense physical labour.
10. Pregnancy.
11. Patient on dialysis.
ADA workgroup has categories risk in patients with diabetes
who fast during Ramadan as follows

Moderate risk group

Well controlled patients treated with short
acting secretagogues such as repaglinide or
nataglinide
Low risk group
Well-controlled patients treated with diet alone,
metformin or a thiazolidinedione who are
otherwise healthy
ADA workgroup has categories risk in patients with diabetes
who fast during Ramadan as follows

Moderate risk group

Well controlled patients treated with short
acting secretagogues such as repaglinide or
nataglinide
Low risk group
Well-controlled patients treated with diet alone,
metformin or a thiazolidinedione who are
otherwise healthy
 Management of diabetes during
Ramadan
1. General considerations
2. Exercise: Normal level of activity. Excessive
physical activities may lead to
hypoglycemia. Tarawaih prayer can be
considered part of daily exercise
programme.
3. Breaking the fasting: If blood sugar goes <
3.3 mmol/L (60mg /dl) or > 16.7 mmol/L
(300mg /dl). Sick days.
 Management of diabetes during
Ramadan

Patient on diet: No change in total calorie intake. Ensure

three at least meals and adequate fluid intake .
Patient on metformin: Start with single dose at meal
after.
Patient on glitazone: No change.
Patient on sulfonylurea: Use glimiperide at ifter or
rapaglinide/ netiglinide.
Patient on insulin: Use prmixed or combination of
analogs
During Ramadan morning dose at ifter and
half the evening dose at seheri
ADA recommended guideline

Total daily insulin (U) Ifter dose Seheri dose Total

20 13 3 16
21 14 3 17
22 15 3 18
23 15 4 19
24 16 4 20
25 17 4 21
26 17 5 22
27 18 5 23
28 19 5 24
29 20 5 25
30 20 5 25