Ramadan fasting improves diabetes by lowering the blood glucose and HbA1c because of fewer postprandial
peaks. However, certain prinicples should be followed to avoid hypoglycemia because of prolonged fasting.
1. Patient of Diet and Excercise:
Consider modifying the time and intensity of physical activity; ensure adequate fluid intake
2. Patient on Metformin 500mg thrice daily:
Take Metformin, 1,000 mg SR at the sunset meal, 500 mg SR at the predawn meal
3. Patient on sulphonylurea: Sulfonylureas – glimepiride, gliclazide, glibenclamide etc
If you take once a day, dose should be given before the sunset meal; adjust the dose based on the glycemic control and the risk of hypoglycemia
If you take twice daily, use half the usual morning dose at the predawn meal and the usual dose at sunset meal at the end of the fast, with the evening meal started within 30 minutes. Advise not to miss the sunrise meal so as to avoid hypoglycaemia later in the day.
2. Repaglinide (NovoNorm or Eurepa) can be particularly useful, since it need only be taken when a meal
is eaten, therefore no change in drug therapy will be required in Ramadan. A meal must be eaten within 15 minutes of taking novonorm or eurepa.
4. Patient taking TZDs – pioglitazone, AGIs – voglibose , or incretin-based therapies – saxagliptin, vildagliptin or sitagliptin. No change needed
5. Patients on premixed or intermediate-acting insulin twice daily:
Take usual dose at sunset meal and half usual dose at predawn meal
Dr.Ramkumar, MD DNB(Endo) DM(Endo) AIIMS, Consultant – Diabetology/Endocrinology Apollo Hospitals, Chennai.
Source: Guidelines from Professional societies