Diabetes in ramadan

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  • 1. Recommendations for Management of Diabetes During Ramadan Dr. Faisal Al Haddad Consultant of Family Medicine & Occupational Health PSMMC
  • 2. REGULATION OF BLOOD GLUCOSE LEVEL
  • 3. Pre-Ramadan Assessment Medical Assessment. 1 Counseling. 2 Risks of fasting Nutrition Physical activity Breaking the fast Self-care Changes in medications regimen
  • 4. ‫بسم ال الرحمن الرحيم‬ ‫)يأيها الذين امنوا كتب عليكم الصيام كما كتب على الذين‬ ‫من قبلكم لعلكم تتقون‪ ‬أياما معدودات فمن كان منكم‬ ‫مريضا أو على سفر فعدة من أيام أخر وعلى الذين يطيقونه‬ ‫فدية طعام مسكين فمن تطوع خيرا فهو خير له وان‬ ‫تصوموا خيرا لكم ان كنتم تعلمون )‪‬‬ ‫صدق ال العظيم‬
  • 5. RISKS ASSOCIATED WITH FASTING Hypoglycemia. 1 Hyperglycemia. 2 Dehydration. 3
  • 6. NUTRITION  Ingestion of large amounts of foods at Iftar meal, should be avoided.  Ingestion of foods containing “complex” carbohydrates advisable at Suhur meal, while foods with more simple carbohydrates more appropriate at Iftar meal.  Fluid intake should be increased during nonfasting hours.  Suhur meal should be taken as late as possible before the start of the daily fast.
  • 7. PHYSICAL ACTIVITY  The exercise program should be modified in its intensity and timing to avoid hypoglycemic episodes.  Tarawaih prayer should be considered a part of the daily exercise program.
  • 8. BREAKING THE FAST 1. Blood glucose < 60 mg/dl. 2. Blood glucose < 70 mg/dl in the first few hours after the start of the fast . 3. Blood glucose > 300 mg/dl . 4. Acute illness.
  • 9. SELF CARE  Frequent blood glucose monitoring.  Management of acute complications.  Changes in their medications.
  • 10. ORAL HYPOGLYCEMIC AGENTS Metformin Glitazones decrease insulin resistance Sulfonylureas Meglitinides increase insulin secretion
  • 11. ORAL HYPOGLYCEMIC AGENTS :Metformin● of the daily dose should be given before Iftar 2/3 .meal, and the other third given before Suhur meal  Glitazones : no change.  Meglitinides : short-acting Meglitinides can be taken twice daily before Iftar and Suhur meals .
  • 12. ORAL HYPOGLYCEMIC AGENTS Sulfonylureas●  long acting agents (chlorpropamide) is absolutely contraindicated.  Newer sulfonylureas (gliclazide MR) associated with lower risk of hypoglycemia.  If the usual dose is once a day, the dose should be given before the Iftar meal.  if twice a day, give the full dose at Iftar meal and half the dose at Suhur meal.
  • 13. TYPES OF INSULIN TYPE NAME ONSET PEAK DURATION Rapid Acting Humalog) Lispro) min 15 - 5 min 90 - 30 hours 5 - 3 Short Acting Regular one hour½ - hours 2-4 hours 6-8 Intermediate NPH Lente hours 1-3 hours 6-10 hours 10-16 Long Acting Ultralente Lantus) Glargine) hours 4-6 hours 1-2 hours 18 No peak hours 24-36 hours 24-36
  • 14. INSULIN  Intermediate )NPH) + Short )regular) premeals.  Long-acting )ultralente) + Short )regular) premeals.  Long-acting analog )glargine) OD , Short )regular) premeals.  Rapid-acting insulin )lispro) can be used instead of short-acting insulin.