1. Dr Amjad Ahmed GPwSI Diabetes

2. What is Ramadan? Ramadan is the ninth month of the Islamic year and can last up to 30 days (17th June to 18th July 2015). Patients can sometimes fast over 20 hours, especially during the summer months requires the abstinence from food and drink during daylight hours. The month of fasting is one of five pillars of Islam and is compulsory upon those who are deemed to be sane, physically fit and have reached puberty. Those who do not fulfil this criteria or pregnant women are exempt from fasting.

3. What happens when patients with diabetes fast?

4. Complications Hypoglycaemia is a recognised complication of diabetes pharmacotherapy but also as result of fasting. Hyperglycemia with or without Diabetic ketoacidosis was shown to be increased by 3 fold in patients with type 1 diabetes(5-17 events/100 people/month) and an increase by 5 fold (1-5 events/100 people/month) in the incidence of hyperglycemia in patients with type 2 diabetes when fasting during ramadhan. Dehydration and thrombosis can occur as a result of reduced fluid intake and osmotic diuresis due to hyperglycemia; this encourages a hypercoagulable state and impaired fibrinolysis.

5. What do we do? Risk stratify: -High Risk: Patients with type 1 diabetes, poor diabetes control, CKD ≥ 3b, pregnant women and those with a history of hypoglycaemia and DKA particularly within the 3 months prior to Ramadan are classed as high risk -Low Risk: Patient with diabetes who are well controlled, diet controlled and those treated with monotherapy. -Remaining patients, especially those being treated with insulin +/- sulphonylurea are categorised as moderate to high risk due to risk of hypoglycaemia, particularly those who are elderly.

6. Treatment Modification

7. Take home message Glucometers – frequency CBG Risk Stratify – patient centric Shared management Post Ramadan review

8. Any Questions?