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This document provides recommendations for fasting during Ramadan for those with diabetes. It categorizes risk levels as very high, high, moderate, and low based on factors like blood sugar control and medical history. For each risk level, it recommends whether fasting is advised against or can be done with/without caution. It also reviews common diabetes medications and provides guidance on any dosage adjustments or precautions needed when taking them during Ramadan fasting. Finally, it outlines the religious opinion of the Egyptian Fatwa Authority, which is that fasting should avoid hardship and harm for all patients with diabetes.
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This document provides information about diabetes mellitus. It defines diabetes as a group of metabolic diseases characterized by high blood glucose levels due to defects in insulin secretion or action. The main types of diabetes are described as type 1, type 2, and gestational diabetes. Symptoms, diagnostic criteria, risk factors, and management strategies like nutrition, exercise, medication and insulin therapy are discussed for each type. The goals of diabetes management are to control blood glucose levels through diet, exercise, oral hypoglycemic drugs, and insulin in order to prevent long-term health complications.
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This document discusses medical considerations and recommendations for managing diabetes during Ramadan. It notes that fasting is prohibited if it poses health risks. For those with diabetes who choose to fast, risks include hypoglycemia, hyperglycemia, dehydration, and electrolyte abnormalities. It provides guidelines on fasting for those with type 1, type 2, or using insulin based on their risk level and treatment plan. Doctors should discuss concerns with patients and encourage frequent monitoring if fasting.
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- Studies like the Diabetes Prevention Program showed that modest lifestyle changes like 5-10% weight loss and moderate physical activity can prevent or delay the onset of diabetes in those with pre-diabetes.
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This document discusses guidelines for managing diabetes during Ramadan, including:
1) Individualizing treatment plans and frequent glucose monitoring are essential due to risks of hypoglycemia and hyperglycemia from fasting.
2) For Type 1 diabetics and poorly controlled Type 2 diabetics, intensive insulin therapy with multiple daily injections or insulin pumps is recommended to carefully manage glucose levels.
3) For many Type 2 diabetics, modifying oral medications, medical nutrition therapy, and exercise can allow safe fasting if glucose is closely tracked.
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This document discusses medical considerations and recommendations for managing diabetes during Ramadan. It notes that fasting is prohibited if it poses health risks. For those with diabetes who choose to fast, risks include hypoglycemia, hyperglycemia, dehydration, and electrolyte abnormalities. It provides guidelines on fasting for those with type 1, type 2, or using insulin based on their risk level and treatment plan. Doctors should discuss concerns with patients and encourage frequent monitoring if fasting.
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This document discusses pre-diabetes, including its definition, prevalence, health risks, diagnostic criteria, and treatment options. Some key points:
- Pre-diabetes is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Left untreated, pre-diabetes often progresses to type 2 diabetes.
- Studies like the Diabetes Prevention Program showed that modest lifestyle changes like 5-10% weight loss and moderate physical activity can prevent or delay the onset of diabetes in those with pre-diabetes.
- In addition to lifestyle changes, pharmacologic treatments like metformin may be considered for high-risk individuals to prevent the progression from pre-diabetes to diabetes. However,
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This document discusses guidelines for managing diabetes during Ramadan, including:
1) Individualizing treatment plans and frequent glucose monitoring are essential due to risks of hypoglycemia and hyperglycemia from fasting.
2) For Type 1 diabetics and poorly controlled Type 2 diabetics, intensive insulin therapy with multiple daily injections or insulin pumps is recommended to carefully manage glucose levels.
3) For many Type 2 diabetics, modifying oral medications, medical nutrition therapy, and exercise can allow safe fasting if glucose is closely tracked.
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This document provides treatment guidelines for diabetes mellitus. It discusses the types of diabetes, symptoms, complications, goals of treatment, and treatment options. Treatment involves lifestyle changes like diet and exercise. Pharmacological treatment starts with metformin for type 2 diabetes and insulin for type 1 diabetes. Insulin therapy is initiated at 0.4-1.0 units/kg/day for type 1 diabetes. Additional agents may be added if blood sugar levels remain uncontrolled. The goal of treatment is to achieve a hemoglobin A1c level below 7% through lifestyle management and medication adjustments.
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Fasting during Ramadan poses risks for people with diabetes, especially those with type 1 diabetes who should be advised not to fast. For those who insist, risks include hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis. Management requires individualizing plans based on risk factors, educating patients, adjusting medications like insulin and timing/doses, frequent glucose monitoring, proper nutrition and hydration, and medical supervision. The goal is reducing risks while allowing observance of religious practices.
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3) Lifestyle interventions including nutrition, physical activity and weight management are recommended to reduce the risk of developing diabetes. Drug therapy may also help delay onset of type 2 diabetes in some cases.
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This document discusses diabetes mellitus (DM), including its definition, symptoms, long-term effects, and global burden. DM is characterized by high blood glucose levels resulting from defects in insulin production or action. It can cause serious complications affecting the eyes, kidneys, nerves, and heart. The number of people with DM is growing rapidly worldwide and is projected to reach over 330 million by 2025, with three-quarters living in low- and middle-income countries. India has a particularly high prevalence, with over 77 million adults affected, making it the diabetes capital of the world. Without treatment, DM can be fatal, and it also increases the risks of other diseases like tuberculosis.
Ueda 2016 2-pathophysiology ,classification & diagnosis of diabetes - kha...
This document outlines an agenda and presentation on the pathophysiology, screening, diagnosis and classification of diabetes given at a mini-course in Aswan, Egypt in February 2016. The presentation covers:
1. The normal physiology and definition of diabetes and its chronic hyperglycemia-related complications.
2. The clinical classes of diabetes including type 1, type 2, gestational diabetes and other specific types.
3. The pathophysiology, risk factors, screening and diagnosis of type 1, type 2 and gestational diabetes are discussed in further detail.
4. The goals of the course are to help participants in advance of an upcoming conference on diabetes.
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Ueda 2016 4-non pharmacological diabetes management - emad hamed
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The document discusses diabetes management during Ramadan fasting. It notes that fasting can cause physiological changes and alterations in circadian rhythms that impact glucose homeostasis. For Muslims with diabetes, this poses risks like hypoglycemia and hyperglycemia from changes in medication timing, sleep patterns, and meal schedules. The document provides guidelines for risk assessment and stratification of patients, dietary and activity modifications, and medication adjustments to help patients with diabetes safely observe Ramadan fasting.
Fasting with Diabetes by Dr Shahjada Selim
- Fasting during Ramadan presents risks for those with diabetes like hypoglycemia and hyperglycemia due to changes in eating, sleeping, and medication patterns.
- Diabetic patients should be categorized into very high, high, or moderate/low risk groups based on their health conditions and diabetes control to determine if fasting is safe.
- Those at very high or high risk of complications from fasting, such as those with severe diabetes or other health issues, should not fast during Ramadan. Others may fast with proper education, medical guidance, and glucose monitoring.
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The document discusses various types of oral hypoglycemic agents (OHAs) used to treat type 2 diabetes mellitus (T2DM). It describes the classifications of OHAs including biguanides like metformin, sulphonylureas, meglitinides, thiazolidinediones, and others. For each class, it provides details on mechanisms of action, pharmacokinetics, dosing, side effects, and contraindications. Metformin and sulphonylureas have been used the longest and remain first-line treatment options, though each class has advantages and disadvantages discussed in the document.
Management of diabetes mellitus
The document outlines management goals and treatment strategies for diabetes mellitus. The main goals are to eliminate hyperglycemia symptoms, reduce microvascular and macrovascular complications, and allow patients to achieve a normal lifestyle. To achieve these goals, physicians should identify an appropriate glycemic target for each patient and provide education, medications, and complication monitoring and treatment. Comprehensive diabetes care involves emphasis on nutrition, exercise, medication, and glycemic control monitoring, and often requires glucose-lowering medications.
Dyslipidemia in a high risk patient
This patient is at high risk for atherosclerosis based on age, smoking, hypertension, and lipid profile. The doctor recommends starting rosuvastatin 20mg daily along with lifestyle modifications. Regular lipid profiles and liver function tests are advised. While omega-3 may lower triglycerides, higher doses could increase LDL. Muscle aches are not necessarily due to statins, and risk of diabetes from statins is small compared to cardiovascular protection.
DM Saudi Guidelines By DR. Wedad Bardisi.pptx
The document provides guidelines for managing diabetes in primary health care settings in Saudi Arabia. It finds the prevalence of diabetes in Saudi Arabia has increased significantly in recent decades and places a large economic burden on the health system. It recommends screening those over 40 or at high risk every 3 years and treating prediabetes to prevent progression to diabetes. The guidelines advise treating diabetes with lifestyle changes and metformin initially, adding other oral drugs or insulin if targets are not met, with the goal of maintaining an A1C level below 7%.
Global Prevalence of Diabetes and IDF for managing Type 2 Diabetes in Primar...
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Global Prevalence of Diabetes and IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care by Dr Shahjada SelimDM PPT.pptx
This document provides an overview of diabetes mellitus (DM), including its causes, symptoms, types, complications, management, and prevention. DM is characterized by high blood glucose levels due to defects in insulin production or action. It can cause damage to various organs and is associated with cardiovascular and other diseases. There are three main types of DM: type 1, type 2, and gestational diabetes. Lifestyle changes including diet and exercise are the primary treatment approach. If blood glucose levels remain high, oral medications and/or insulin may be needed to manage the condition. Early detection and treatment can help prevent or delay diabetes and its complications.
GDM.pptx
This document discusses diabetes mellitus in pregnancy. It defines gestational diabetes as glucose intolerance that develops during pregnancy, affecting 3-9% of pregnancies. Risk factors include family history of diabetes and older age. Insulin resistance is a normal phenomenon in pregnancy that can progress to gestational diabetes. Screening involves an oral glucose tolerance test. Management includes diet, exercise, glucose monitoring, and possible insulin or metformin therapy. Complications for both mother and baby include preterm labor, preeclampsia, macrosomia, and neonatal hypoglycemia. Prognosis includes increased risk of developing diabetes later in life.
GDM_ Dr Selim
1) Gestational diabetes mellitus (GDM) is a form of diabetes diagnosed during pregnancy that is not clearly type 1 or type 2 diabetes. It results from the body's inability to produce enough insulin or use it effectively, and puts both mother and baby at risk.
2) GDM is tested for between 24-28 weeks of gestation using a glucose challenge test and potentially an oral glucose tolerance test. It is treated through diet, exercise, blood glucose monitoring, and potentially insulin.
3) Both mother and baby can experience risks if GDM is not managed well, such as preeclampsia, macrosomia, and long-term metabolic disorders. Ongoing screening is important after pregnancy to
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Ueda2016 recommendations for management of diabetes during ramadan - update 2...
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- 1. Recent Recommendation for Safe Fasting Ramadan BY Dr. Salwa Mahmoud Elwasif
- 3. In 337 pages 15 chapters published in Jan. 2021
- 6. Very high risk: fasting not recommended • ► Severe hypoglycemia within the 3 months prior to Ramadan. • ► Severe hyperglycemia with average fasting or premeal plasma glucose >16.7mmol/L (300mg/dL) or glycated hemoglobin (HbA1c) >86mmol/mol (10%). • ► A history of recurrent hypoglycemia or hypoglycemia unawareness. • ► Diabetic ketoacidosis/hyperosmolar hyperglycemic state within the 3 months prior to Ramadan. • ► Acute illness. • ► Performing intense physical labor. • ► Pregnancy. • ► Chronic dialysis. • ► Patients with significant dementia or cognitive deficits.
- 7. High risk: may choose not to fast • ► Moderate hyperglycemia (average blood glucose 8.3–16.7mmol/L (150–300mg/dL) or HbA1c 64– 86mmol/mol (8%–10%)). • ► Significant microvascular or macrovascular complications. • ► Living alone and treated with insulin or sulfonylureas. • ► Patients with comorbid conditions that present additional risk factors like heart failure, stroke, malignancy, renal impairment. • ► Elderly >75 years of age.
- 8. Moderate risk: may choose to fast with caution • People with type 2 diabetes with no complications and HbA1c <64mmol/mol (8%) • treated with lifestyle intervention, metformin, thiazolidinedione (TZD), incretin-based therapies, sodium glucose cotransporter-2 inhibitors and/or short-acting insulin secretagogues.
- 9. Low risk: may choose to fast • ► People with type 2 diabetes with no complications and HbA1c <53mmol/mol (7%) treated with lifestyle intervention, metformin, TZD and/or incretin-based therapies.
- 11. Metformin: • It has a long history of safety and efficacy and remains the first-line medication for management of type 2 diabetes either alone or in combination. • Usually, no dose change is advised during Ramadan, but timings need to be reviewed for Ramadan
- 12. Glucagon-like peptide-1 receptor agonist (GLP-1RA): • GLP1RA agents are effective in improving glycemic control with low risk of hypoglycemia or weight gain • should be started at least 4–8 weeks prior to fasting with titration to tolerated dose before the start of Ramadan.
- 13. Dipeptidyl peptidase-4 inhibitor (DPP4 inhibitors): • the ADA/EASD consensus recommends DPP4 inhibitors as an add-on option to metformin where there is a compelling need to minimize hypoglycemia • It is weight neutral and have a low risk of hypoglycemia but when combined with SU, the risk of hypoglycemia is increased by 50%
- 14. Thiazolidinediones (TZD) • TZD use is not associated with hypoglycemia and is recommended as one of the add on options to metformin in fasting patients • TZD is an attractive option in lower middle- income countries where cost consideration is a major issue. TZD should be avoided in patients with history of HF.
- 15. Sulfonylurea (SU): • SUs have widespread availability but are known to increase the risk of hypoglycemia, which is of great concern during Ramadan. • The newer generation SU like glipizide, glimepiride and gliclazide have a lower risk of hypoglycemia compared with older and longer-acting agents.
- 18. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) • potential risk of volume contraction and postural hypotension, especially in warm climates with long fasting hours and risk of diabetic ketoacidosis (DKA). • not starting SGLT2i as a new medication during or immediately prior to Ramadan and patients should be well established on these drugs prior to start of Ramadan. • Elderly patients, renal impairment, hypotensive patients or those on diuretics should proceed with caution and consider stopping or reducing the dose of SGLT2i
- 22. RELIGIOUS OPINION OF THE MOFTY OF EGYPT • According to document from The Egyptian Official Fatwa Authority, produced on January 11, 2021, religious recommendations for individuals with diabetes planning to fast the holy month of Ramadan were based on two principles: avoiding hardship and eliminating potential physical harm to all patients.