Wednesday, 22 August 2012

People with diabetes may fast safely during Ramzan through careful planning before the fasting month begins, says an international team of endocrinologists and metabolism experts

By Syed Akbar
Hyderabad: People with diabetes may fast safely during Ramzan
through careful planning before the fasting month begins, says an
international team of endocrinologists and metabolism experts.


The team, comprising expert doctors from various medical colleges in
India, Pakistan and Bangladesh, has come out with “South Asian
Consensus Guidelines” on fasting during the Islamic holy month of
Ramzan, which begins later this week. Endocrinologist Dr Rakesh Kumar
Sahay of Osmania Medical College, Hyderabad, is part of the research
team.


“It is possible for people with diabetes to fast safely during
Ramadan,” the South Asian Consensus Guidelines point out. However, the
guidelines caution that the diabetics, who plan fasting, should do
careful planning to avoid problems that could be serious and have
long-term effects.

The pre-Ramzan planning includes the choice of insulin therapy,
decided by the previous regimen that the patient is taking, and the
blood glucose profiles. “The major objective of insulin therapy during
Ramzan is to provide adequate insulin to prevent the post meal
hyperglycemia (high blood sugar levels) and also prevent hypoglycemia
(low blood sugar levels) during the period of fast. With the use of
analogues, these objectives may be met more easily,” the expert team
noted in its Ramzan Consensus published in the latest issue of the
Indian Journal of Endocrinology and Metabolism.

The Consensus Statement for the first time discussed pre-Ramzan
assessment, planning, prescription, management, and monitoring of
patients on insulin, who wish to fast.

“Considering certain metabolic changes we have to adjust the
management of diabetes during Ramzan. In our daily practice, we come
across both type 1 and type 2 diabetes mellitus and we have to manage
them during the Ramzan period. Planning should be important to decide,
whether they can fast and if they can fast, how their diabetes can be
managed while performing all the rituals of Ramzan,” the experts
observed.

They suggested that diabetics should “consider” avoiding fasting in
case of pregnancy and lactation, acute peptic ulcer, severe bronchial
asthma, pulmonary tuberculosis, cancer, overt cardiovascular diseases
like recent myocardial infarction, sustained angina (pain) and hepatic
(liver) dysfunction.

The Consensus Statement has classified diabetics, who wish to fast
during Ramzan, into four categories, very high risk, high risk,
moderate risk and low risk. Those in the very high risk include
diabetics with severe hypoglycemia within the last three months prior
to Ramzan, patients with a history of recurrent hypoglycemia, those
with hypoglycemia unawareness and sustained poor glycemic control,
ketoacidosis and hyperosmolar hyperglycemic coma within the last three
months, acute illness and those on dialysis.

The high-risk category has patients with renal insufficiency, advanced
macrovascular complications, autonomic neuropathy, and people living
alone and are treated with multiple insulin injection or sulfonylureas
and patients in old age with ill health.

Those in the moderate risk group are well-controlled patients treated
with short-acting insulin, while the low risk category comprises
well-controlled patients treated with diet alone, metformin, or a
thiazolidinedione, and who are otherwise healthy.

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