*Patients who are on diet-control only can definitely fast, and this may help them lose weight thus improving their condition
*Patients with well-controlled type 1 diabetes who use insulin pumps can often accomplish fasting by adjusting their basal infusion rates and monitoring their blood glucose levels frequently
*For patients with type 2 diabetes taking medications other than insulin or sulfonylureas (Amaryl, Glucovance), the risk for hypoglycemia is low. Patients who usually take metformin (Glucophage) 3 times daily should take 2/3's of the dose at Iftar and 1/2 at Suhour.
*Long-acting sulfonylureas should be avoided. Once-daily sulfonylureas should be taken at Iftar. The ADA guidelines state that for patients taking twice-daily sulfonylureas, the usual dose should be taken at Iftar and 1/2 the usual dose before Suhour, though some prefer to skip the Suhour dose altogether fear of hypoglycemia. However, the very short-acting insulin secretagogues repaglinide or nateglinide (Starlix, Novartis) can be taken before each of the meals.
*No adjustments are needed for thiazolidinediones, alpha-glucosidase inhibitors, incretin-based therapies, or bromocriptine (Cycloset, VeroScience/Santarus).
*Basal insulin doses should be reduced by about 30% to 40%. The ADA recommends switching patients who are on either mixed or intermediate-acting insulins to basal insulin.
*The usual dose of rapid-acting insulin should be taken before Iftar. Again, while the ADA guideline advises cutting the Suhour dose of rapid-acting insulin in half, others advise to cut it out completely.
Please remember: If you develop low blood sugar symptoms (<70) in the daytime, break the fast immediately. If you take insulin &want to fast, do so under close medical supervision. Follow a diabetic diet when fasting (avoid Ramadan sweet). Check your blood sugar frequently, if >250 break your fast &take insulin.
•
patient on well controlled diet are candidate to fast also wellcontrolled type 1 and type 2 for type2 not on insulin nor on sulfonuria with medical control
•
