Pre-Ramadan education on safe fasting can help diabetic patients fast safely during Ramadan. A study from Bangabandhu Sheikh Mujib Medical University found that providing structured education before Ramadan on topics like meal planning, exercise, medication adjustment, blood sugar monitoring and complication management reduced the risk of hypoglycemia compared to patients who did not receive the education. The education program emphasized the need for medical assessment before Ramadan and encouraged blood glucose testing while fasting. It also stressed recognizing and managing complications. The study found lower rates of hypoglycemia and improved biochemical parameters in patients who completed the pre-Ramadan education program compared to those who did not.

1. EFFECTS OF PRE-RAMADANEFFECTS OF PRE-RAMADAN
EDUCATION ON SAFE FASTINGEDUCATION ON SAFE FASTING
Prof. M. FariduddinProf. M. Fariduddin
Founder Chairman & Course CoordinatorFounder Chairman & Course Coordinator
Department of EndocrinologyDepartment of Endocrinology
Bangabandhu Sheikh Mujib Medical UniversityBangabandhu Sheikh Mujib Medical University
Shahbag, Dhaka, BangladeshShahbag, Dhaka, Bangladesh
Email: dr.md.fariduddin@gmail.comEmail: dr.md.fariduddin@gmail.com

2. ADA/EASD Treatment algorithmADA/EASD Treatment algorithm

3. What happens in Ramadan?
⇒ Eating habit changes in many ways
- Meal time
- Pattern of meal
- Calorie intake
⇒ Increased post-prandial physical
activity during the night associated with
Tarawih
⇒ Mental change -> religious feelings
Can Fam Physician 2014;60:508-10Can Fam Physician 2014;60:508-10

4. Frequently asked questions during RamadanFrequently asked questions during Ramadan
 Can a diabetic patient fast?Can a diabetic patient fast?
 What are the risks & benefits associated withWhat are the risks & benefits associated with
fasting?fasting?
 What about diet and exercise?What about diet and exercise?
 How to adjust drugs?How to adjust drugs?
 Can a patient monitor blood sugar while fasting?Can a patient monitor blood sugar while fasting?
All can be answered byAll can be answered by
Pre-Ramadan EducationPre-Ramadan Education

5. PHYSICIAN’S ROLEPHYSICIAN’S ROLE
Guidance and advice to allowGuidance and advice to allow
diabetic patients for safe fastingdiabetic patients for safe fasting

6. For safe fasting patient needs-For safe fasting patient needs-
1.1. Pre-Ramadan assessmentPre-Ramadan assessment
2.2. Ramadan focused structuredRamadan focused structured
education & motivationeducation & motivation
3.3. Patient centered individualizedPatient centered individualized
management planmanagement plan

7. Pre-Ramadan AssessmentPre-Ramadan Assessment
1.1. Assessment of glycemic statusAssessment of glycemic status
2.2. Assessment of complications & co-Assessment of complications & co-
morbid conditionsmorbid conditions
3.3. Assessment of patient’s abilityAssessment of patient’s ability
FAST or not to FASTFAST or not to FAST

8. Conditions related to diabetes:Conditions related to diabetes:
- Advanced nephropathy- Advanced nephropathy
- Severe retinopathy- Severe retinopathy
- Autonomic neuropathy- Autonomic neuropathy
- Hypoglycemic unawareness- Hypoglycemic unawareness
- Major macrovascular diseases- Major macrovascular diseases
- Recent hyper-osmolar state or DKA- Recent hyper-osmolar state or DKA
- Poorly controlled diabetes (Mean RBG> 300)- Poorly controlled diabetes (Mean RBG> 300)
- Multiple insulin injections per day- Multiple insulin injections per day
Patients with one or more of the following are advised not to fastPatients with one or more of the following are advised not to fast
Physiological conditions:Physiological conditions:
- Pregnancy- Pregnancy
- Lactation- Lactation
Ramadan Guideline: Diabetes and Ramadan Advisory Board
Clinical Diabetes ( Middle East Edition)- Volume 3, Number 3, 2004

9. Co-existing major medical conditions such as:Co-existing major medical conditions such as:
- Acute peptic ulcer- Acute peptic ulcer
- Severe Pulmonary Tuberculosis- Severe Pulmonary Tuberculosis
- Severe infection- Severe infection
- Severe bronchial asthma- Severe bronchial asthma
- Recurrent stones formation- Recurrent stones formation
- Cancer with poor general condition- Cancer with poor general condition
- Overt cardiovascular diseases (Recent MI)- Overt cardiovascular diseases (Recent MI)
- Severe psychiatric conditions- Severe psychiatric conditions
- Hepatic dysfunction (liver enzymes > 2 × ULN)- Hepatic dysfunction (liver enzymes > 2 × ULN)
Clinical Diabetes ( Middle East Edition)- Volume 3, Number 3, 2004
Patients with one or more of the following are advised not to fastPatients with one or more of the following are advised not to fast
Ramadan Guideline: Diabetes and Ramadan Advisory Board

10. EDUCATIONEDUCATION

11. EducationEducation
Educate the patients regardingEducate the patients regarding
– Ramadan & DiabetesRamadan & Diabetes
– Meal planningMeal planning
– Physical activityPhysical activity
– Drug adjustmentDrug adjustment
– Blood sugar monitoringBlood sugar monitoring
– Acute complications & their managementAcute complications & their management

12. Results of the Epidemiology of Diabetes and Ramadan
1422/2001 (EPIDIAR) study
A population-Based study of
Diabetes and Its Characteristics
During Fasting Month Ramadan in 13 Countries
DiabetesCare, October 2004
Total patients: 12,243
Type 1 diabetes: 1,070 (8.7%) 42.8%
Type 2 diabetes: 11,173 (91.3%) 78.7%
Less than 50% of the whole population changed their treatment dose
(approximately one forth of the patients treated with oral antidiabetic
drugs and one third of the patients using insulin)
Severe hypoglycemic episodes:
For Type 1 diabetes: 0.14 vs 0.03 episodes/ month, P= 0.0174
For Type 2 diabetes: 0.03 vs 0.004 episodes/ month, P= <0.0001

13. The READ* study 2007: SummaryThe READ* study 2007: Summary
Diabet. Med. 27, 327–331 (2010)
* READ: Ramadan Education and Awareness in Diabetes* READ: Ramadan Education and Awareness in Diabetes

14. Effects of Pre-RamadanEffects of Pre-Ramadan
Education on SafeEducation on Safe
Ramadan Fasting- 2014Ramadan Fasting- 2014
BSMMU experienceBSMMU experience

15. Pre-Ramadan Structured Education Program
Ramadan-focused
Meal planning and dietary advice:
The diet during Ramadan should not differ
from a healthy balanced diet
To encourage slow energy-release food (such
as wheat, semolina, beans, rice)
To minimize food high in saturated fat (such
as ghee, samosas and pakoras)
Exercise:
To take light and moderate exercise on a
regular basis
To avoid rigorous exercise during evening
times because of risk of hypoglycaemia
Medical assessment:
To encourage patients to seek medical advice
from their general practitioners before
Ramadan with regarding to any necessary
medication change or dose adjustment
Diabetes-related
Blood glucose monitoring:
To stress that blood glucose testing does not
constitute breaking fast
Patients who fast should know how to test
their capillary blood glucose
We encourage patients to test their blood
glucose when symptomatic or unwell
Recognizing and managing complications:
How to recognize major symptoms of
hypoglycaemia and hyperglycaemia
How to manage hypoglycaemia
For patients’ safety, to stress the need to
break the fast when hypoglycaemia occurs
To encourage patients to seek further medical
help if complications occur

16. Hypoglycemia among Structured and Non-
Structured Education Group at Enrollment

17. Hypoglycemia among Structured and Non-
Structured Education Group

18. Comparison between biochemical parameters of Group
A (structured ) and group B (non structured) at
education program at baseline and post-Ramadan

19. Pre-Ramadan Structured Education

20. Pre-Ramadan Structured Education

21. Take Home MessagesTake Home Messages
Uncomplicated type 2 diabetic patients can fast
during Ramadan safely
Pre-ramadan education and motivation is very
important to prevent diabetic related
complications- hypoglycemia
Islam allows diabetics to have regular blood test
while fasting
Fasting along with regular prayer have been
proved to aid in better control of diabetes
Ramadan focused structured education and
individualized patient centered approach are the
cornerstone of safe fasting

22. Thank You AllThank You All