Diabetes in ramadan
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Transcript of Diabetes in ramadan
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
1 .Medical Assessment
2 .Counseling Risks of fasting
Nutrition Physical activity Breaking the fast
Self-care Changes in medications regimen
الرحيم الرحمن الله بسم
كتب ) كما الصيام عليكم كتب امنوا الذين يأيهاتتقون لعلكم قبلكم من الذين أياما على
سفر على أو مريضا منكم كان فمن معدوداتفدية يطيقونه الذين وعلى أخر أيام من فعدة
له خير فهو خيرا تطوع فمن مسكين طعامتعلمون كنتم ان لكم خيرا تصوموا )وان
العظيم الله صدق
RISKS ASSOCIATED WITH FASTING
1 .Hypoglycemia
2 .Hyperglycemia
3 .Dehydration
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.
ORAL HYPOGLYCEMIC AGENTS
Metformin decrease insulin resistance
Glitazones
Sulfonylureas increase insulin secretion
Meglitinides
ORAL HYPOGLYCEMIC AGENTS
●Metformin: 2/3 of the daily dose should be given before Iftar
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.
TYPES OF INSULIN
TYPE NAME ONSET PEAKDURATION
Rapid Acting(Humalog( Lispro 5 - 15 min30 - 90 min3 - 5 hours
Short ActingRegular - ½one hour2-4 hours6-8 hours
IntermediateNPH
Lente
1-3 hours6-10 hours10-16 hours
Long ActingUltralente
(Lantus( Glargine
4-6 hours
1-2 hours
18 hours
No peak
24-36 hours
24-36 hours
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.