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Can a Diabetic Fast in Ramazan Who When amp How
Dr Ammar RazaDPH Dip Diabeto MBA FICC (USA) FRSM (UK) MIPHADiabetes Care Physician Kare Diagnostics amp Polyclinic amp Medical Director AstraZeneca India
My Beloved Father Late Moulana Syed Karrar Hussain Baaqri
Dedicate This to
Content
Background Diabetes A ldquoBigrdquo Growing Problem Ramazan Fasting Mandatory but there are
exemptions Three Big Questions for a person with Diabetes
1 Who can you fast Who canrsquot fast2 How to go about What precautions to take3 What about diet control medications blood tests
etc
Fastinghellip The Holy Book says
ldquoO you who believe fasting is prescribed to you as it was prescribed to those before
you so that you can learn Taqwa (Quran 2183)
Ramazan The Holy Month
bull Exercise self discipline
bull Psychological effect
bull Additional prayers
Uniqueness of Islamic Fasting
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
My Beloved Father Late Moulana Syed Karrar Hussain Baaqri
Dedicate This to
Content
Background Diabetes A ldquoBigrdquo Growing Problem Ramazan Fasting Mandatory but there are
exemptions Three Big Questions for a person with Diabetes
1 Who can you fast Who canrsquot fast2 How to go about What precautions to take3 What about diet control medications blood tests
etc
Fastinghellip The Holy Book says
ldquoO you who believe fasting is prescribed to you as it was prescribed to those before
you so that you can learn Taqwa (Quran 2183)
Ramazan The Holy Month
bull Exercise self discipline
bull Psychological effect
bull Additional prayers
Uniqueness of Islamic Fasting
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Content
Background Diabetes A ldquoBigrdquo Growing Problem Ramazan Fasting Mandatory but there are
exemptions Three Big Questions for a person with Diabetes
1 Who can you fast Who canrsquot fast2 How to go about What precautions to take3 What about diet control medications blood tests
etc
Fastinghellip The Holy Book says
ldquoO you who believe fasting is prescribed to you as it was prescribed to those before
you so that you can learn Taqwa (Quran 2183)
Ramazan The Holy Month
bull Exercise self discipline
bull Psychological effect
bull Additional prayers
Uniqueness of Islamic Fasting
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fastinghellip The Holy Book says
ldquoO you who believe fasting is prescribed to you as it was prescribed to those before
you so that you can learn Taqwa (Quran 2183)
Ramazan The Holy Month
bull Exercise self discipline
bull Psychological effect
bull Additional prayers
Uniqueness of Islamic Fasting
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Ramazan The Holy Month
bull Exercise self discipline
bull Psychological effect
bull Additional prayers
Uniqueness of Islamic Fasting
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
bull Exercise self discipline
bull Psychological effect
bull Additional prayers
Uniqueness of Islamic Fasting
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting + Diabetes = Good Bad or Ugly
Wajib - part of lsquoFuroadeenrsquo There are exemptions Medical Benefits + + Psychological benefits + Teaches self restrain Brings discipline Feel for lsquohave notsrsquo
Sugar ComplaintCommon Disease Increasing lsquonowrsquoHealth risks involvedNo Cure Needs close monitoring Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
What is Diabetes
Group of longstanding derangement characterized by high blood sugar levels (hyperglycemia) resulting from defects in
Insulin secretion- Less insulin Insulin action- lack of effect of insulin or Both
Chronic high blood sugar levels of diabetes are associated with long-term damage dysfunction and failure of various organs especially
Eyes Kidneys Nerves Heart Blood vessels
American Diabetes Association [ADA] ndash 1997
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
10
Diabetes An Ancient Disease with a Rich Past
Susruta6th century BC
Aretaeus 120-200 AD 980-1037 AD
Ebers Papyrus1550 BC
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Explosion of Diabetes A common disease NOW a days No of people affected is increasing at an alarming pace
world-over Increase is more predominately seen in countries like
India Can affect any individual including Muslim men or
women Basically there are 2 types of diabetes Type 1 amp Type 2
Type 2 diabetes is more common amp affects mostly overweight people now occurs even in young individuals in 20s amp 30s
Can be treated with tablets +- insulin in addition to diet control amp regular exercise
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Prevalence 91httpwwwidforgdiabetesatlas (last accessed 22 Nov 2013)
Diabetes A Big Global ProblemBigger local problem
382 million
592 million
2013 2035
No of people with Diabetes
651 million
2013 2035
109 million
No of people with Diabetes
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Readerrsquos D
igest Nov
2008
Young Face of IndiaYoung Face of
Diabetes in India
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Mohan V et al Indian J Med Res 2007 125217-230
India ldquoDiabetes is EVERYWHERErdquo
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting Helps in a no of ways
Fasting during the holy month of Ramazan provides an opportunity to all of us to adapt a healthy lifestyle teaches us disciple self-restraint and control
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting Medical Benefits (12) Medical literature suggests that
there are medical benefits of fasting during Ramadan
Medical benefits are never the sole reason for taking up fasting they are secondary in nature
Fasting in general has been used by patients for weight management to rest the digestive system and for lowering amount of fat in the body
Seen only in those who maintain appropriate diets
Said 1400 yrs ago
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting Medical Benefits (22)
According to medical research from across the globe Can help lower blood sugar levels Can lower the amount of cholesterol (fat) in the body Possible lowering of blood pressure (BP) May help lower weight (1-3 kgs) in diabetics this benefit
may or may not be seen Provides psychological benefits - peace and tranquility for
those who fast Personal hostility reaches minimum levels and the crime rates are reduced
Seen only in those who maintain appropriate diets
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Diabetic Wishes to Fasthellip4 Key Questionshellip
Who can fast amp who shouldnrsquot
1
What precautions to take
2 What about medications -
what modifications are
reqd
3
Are there any special dietary recommendations
4
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Who Can Fast amp Who shouldnrsquot
There are indications that fasting will no way worsen health of an individual
Experts recommend that those who are suffering from severe diseases diabetes (esp if uncontrolled) heart disease kidney stones Pregnant Women are exempt from fasting amp should not try to
fast
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Among Diabetics who can fast People with well-controlled diabetes - must do it
only under medical supervision Follow UR physicianrsquos advice - before amp during fasting period
like always Some recommend obligatory fasting in people with
diabetes who are overweight amp have diabetes that is well under control
Those who are on 1 or 2 tablets for treatment with appropriate instruction about meals amp use of tablets lsquoWatch out for low sugarsrsquo
if u develop any problems indicative of low sugar they have to immediately report to their physician for appropriate changes in medication amp diet
radic
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Among Diabetics who canrsquot fast
Do not usually follow medical advise
Diabetes + other illnesses eg high amp uncontrolled BP heart ailments infection
Who have already experienced either high or low sugar more than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS gt250 mg)
Pregnant women with diabetes
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Diabetes amp Fasting What precautions to take
Patient with the help of his doctor should change his medication to suit his eating patterns (as he skips lunch) A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their appropriate diets Excess fat amp rich foods should be avoided
Overexertion or rigorous exercise should be avoided during the period of fasting but it is strongly recommended that those with diabetes continue their usual (routine) physical activity especially during non-fasting periods
Regular testing of blood sugars is important before the sunset meal and three hours afterwards and also before Sehri
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
What are the major risks associated with fasting in diabetes
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting Diabetic Dorsquos Any signs of low sugar if at all present even
though rare should be recognized early and patient must seek medical advice ASAP
A consultation with the doctor BEFORE RAMAZAN BEGINS- blood testing
education counselling change in medications
IMMEDIATELY AFTER RAMAZAN - important to adjust medicines and re start therapy like before Ramadan
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Dorsquos Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs Advice
+-
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Pre-Ramadan medical assessment and counselling
All diabetic patients wishing to fast should receive counselling 1 to 2 months before the onset of fasting
Medical assessment Educational Counselling
+
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Quran recommendshellip
What about Diet in Ramazan
ldquoEat of the good things We have provided for your sustenance but
commit no excess therein [Holy Qurrsquoan (2081)]
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Nutrition in Ramazan
50 to 60 maintain body weight while 20 to 25 gain or loose weight
Maintain healthy diet Eat complex carbohydrate advised at
seher meal more simple carbohydrates at iftar
Avoid food high in fat and sugar
TipsAvoid Sweets Samosa Soft Drinks Ice Cream Fried foods Bakery Items Eat LOT of vegetable (except potato beetroot etc) Some fruits in moderate quantity
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Diet Control during Ramazan
Too much emphasis on preparation of food amp a greater variety and quantity of food consumed than in other times There is no need to consume excess food at
iftar or saher A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active Eat a wide variety of foods
put extra effort into including foods from all the food groups
TipsDONrsquoT SKIP Saher
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Exercise
Normal level of exercise should be maintained
Extreme physical activity should be avoided before sunset
Tips Walk after Iftar
Avoid Exercise in the middle of the day (esp afternoonsevenings)
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
2005 Recommendations
bull The common practice of ingesting large amounts of foods rich in carbohydrate and fat especially at the sunset meal should be avoided
bull Fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast
DIABETES CARE VOLUME 28 NUMBER 9 SEPTEMBER 2005
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Breaking the Fast
Patients should break fast if blood glucose lt 60 mgdL
If lt 70 mgdl in first few hours after the start of fasting especially if on insulin or sulfonylureas
If blood glucose gt300 mgdl Avoid fasting on sick days
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
When in Troublehellip
The moment patient is in trouble do not bide for time ndashmust break fast immediately since heroic acts of misplaced piety have nothing to do with the teachings of Islam
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Injecting during fasting
Questionndash Is it permissible to inject a needle and the nutrient during the state of fasting
Answerndash Injecting a medicine or other via a needle in a muscle or the jugular vein does not invalidate the fast Similarly using liquid drops in the ear or the eye does not invalidate the fast even if it caused an appearance of colour or taste in the mouth Also the fast is not invalidated by using the spray that facilitates the respiratory process if the substance goes in the wind wipe and not the food pipe
wwwsistaniorg
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
WHEN YOU WERE BORN EVERYONE WAS SMILING BUT YOU WERE CRYING
LIVE SUCH A LIFE THAT WHEN YOU DEPART EVERYONE IS WEEPING BUT YOU ARE SMILING
Sarsquodi of Shiraz (d 1292)
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Further Reading pl visit the following website
httpwwwalmahdicentrecomarticle3html
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Have a Blessed Ramazan
Thanks
Questions amp Answers
Iltemaas - e - Dua
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
My Beloved Father Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Back Up
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting for NIDDM (ref3) Benefits of Fasting in Ramadan A Better control of Diabetes B Better control of Hypertension C Better control of Lipid D 5-10 lb weight loss
Thus Fasting is advised for stable NIDDM
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
NIDDM- Recommendations Control your Diabetes for two months prior
to Ramadan bringing HbA1c to lt 8 Discontinue Metformin a week before fast Drugs like Actos Avandia Glucotol XL are
safer than Diabeta Amyril and Starlix Continue Diabetic diet in Iftaar and Sahur
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting for those on Insulin Consult your Diabetologist (Muslim) first Discontinue Insulin mixtures such as
7030 7525 or Regular Insulin If on NPH then reduce the total dose by
20 and take 23 at Iftaar and 13 at Sahur If on Lantus then reduce by 20 and take
at night -Titrate by 2 units ( BG 120-140) Take 4-6 units of fast acting Insulin such
as Novolog or Humalog before two meals
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Exemptions From Fasting International consensus meeting held in Morocco 1995
Type 1 diabetes Type 2 diabetes unstable disease Diabetes with complications Pregnant Elderly
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Management General Consideration
Individualization Frequent Monitoring of Glycaemia
Al-Arouj et al Diabetes Care Vol 28 9 Sep 2005
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Medical Assessment
Hba1c Blood pressure Lipids Specific advice including risk to health
if fasting against medical advice Changes to diet and medication
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Educational Counselling
Self Care Symptoms of Hypo and Hyperglycaemia Blood glucose monitoring Meal planning Physical activity Medication administration Management of acute complications
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Management of type 2 diabetes RamadanPre During
Patient on diet and exercise
Metformin 500mg Tds or SR
TZDrsquos Sursquos once a day
Glicalzide MR 60 mg and Glimipride 4mg
No change needed
Metformin 1gm at dusk meal and 500mg at dawn meal
No change needed Dose to be given at
Dusk meal adjust for hypoglycaemia
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Management of type 2 diabetes Ramadan Pre During
Mix 7030 eg 30units morning and 20 units evening
Use the morning dose at dusk meal and half the evening dose at dawn eg 30 units and 20 units
Consider changing to Glargine or Determir with bolus doses of Lispro and Aspart
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
CONSENSUS FROM 3 INTERNATIONAL MEETINGS ON FASTING
TYPE II DIABETES bullIf doing well on diet control no
problem ndashokay to fast bullIf on Metformin ndashno problem
Metformin is
anti-glycaemic and not Hypoglycaemic
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
If on Sulfonylureas Reverse daynight dosages Take usual morning dose after
Iftar (supper) and reduce dose to possibly frac12at Sehri (early morning meal)
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
If on both Daonil and Metformin 1048708Recommended 1048708Take Daonil and Metformin in usual
dose after Iftar (Evening Meal) 1048708Leave out Daonil at Sheri (early
morning meal) take only Metformin 1048708However if midday sugar levels are
uarrintroduce Daonil in small dose at Sehri time (Early morning meal)
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Prandial regulators Repaglinide may be particularly useful for fasting because of
its short action and it can be taken when eating and not taken when fasting This has been shown to help with glycaemic control during Ramadan compared with sulphonlureas
1048708Research Diabetic control does not deteriorate in Ramadan
Engage in a practice run during Shabaan Fast (like preparing for Comrades)
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
SUMMARY OF RECOMMENDATIONS FOR DIABETIC PATIENTS WISHING
TO FAST
1048708Diet Control 1048708Make the pre-dawn meal the major
meal of the day 1048708Space meals equally over the non-
fasting period
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
Fasting in Ramazan
Intermittent fasting (referred to as Roza) - 2nd tenet among the 10 essential tenets - lsquoFuroadeenrsquo -- Shirsquoite school of thought
The primary objectives of this fast is to teach self-restraint to remind Muslims of the plight of their
brothers below poverty line amp can afford one or two meals per day only
![Journal of Diabetes and Metabolism - Open access · predictive value for diabetes beyond fasting plasma glucose (FPG) per se is questioned [7-9]. The American Diabetes Association](https://static.documents.pub/doc/80x56/602c2b68b7914d10045219de/journal-of-diabetes-and-metabolism-open-access-predictive-value-for-diabetes-beyond.jpg)
