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.

12. ORAL HYPOGLYCEMIC AGENTS
Metformin
Glitazones
decrease insulin resistance
Sulfonylureas
Meglitinides
increase insulin secretion

13. 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 .

14. 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.

16. 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

17. 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.