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Management of Diabetes in Ramadan 2010 ADA guidelines

Management of Diabetes in Ramadan
ADA 2010 guidelines

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Management of Diabetes in Ramadan 2010 ADA guidelines

  1. 1. Sahih Internation al[Fasting for] a limited number of days. So whoever among you is ill or on a journey [during them] - then an equal number of days [are to be made up]. And upon those who are able [to fast, but with hardship] - a ransom [as substitute] of feeding a poor person [each day]. And whoever volunteers excess - it is better for him. But to fast is best for you, if you only knew.
  3. 3. Major Updates ★ Addresses voluntary 1-2 days fast per week ★ Discusses effect of prolonged fasting ★ Effect of structured education and support for safe fasting
  4. 4. Major Updates ★ New medications with less risk of hypoglycemia ★ Safety and limitations of existing medications ★ Addresses growing global scope of challenges of diabetes and fasting in ramadan
  5. 5. Major Risks ★ Hypoglycemia ★ Hyperglycemia ★ Diabetic ketoacidosis ★ Dehydration and thrombosis
  6. 6. Management ❏Individualization. ❏Frequent monitoring of glycemia. ❏Nutrition. ❏Exercise. ❏Breaking the fast.
  7. 7. Management ➢Individualisation
  8. 8. Managment ➢Frequent monitoring
  9. 9. Management Nutrition
  10. 10. Management ➢Exercise
  11. 11. Management Break fast ! ➢less than 60 ➢more than 300
  12. 12. Pre-Ramadan Medical Assessment ★ Should take place 1–2 months before ★ Specific attention to overall wellbeing ★ Lab work up ★ Specific advice and potential risks ★ Changes in diet and medication
  13. 13. Ramadan Focussed Structured Education ❖An awareness campaign ❖RFSE for healthcare professionals ❖RFSE for diabetic patients
  14. 14. Type I DM Management High risk ➔Poorly controlled DM ➔Poor compliance to monitoring ➔Unstable glycemic control ➔Recurrent hospitalizations
  15. 15. Type I DM Management Require intensive glycemic control ❖ Multiple daily injections(3+) ❖ Insulin infusion pumps ❖ Frequent monitoring and dose adjustment ❖ Basal bolus is preferred protocol
  16. 16. Type II DM Management Diet controlled patients ● 2-3 smaller meals ● Modified exercise
  17. 17. Oral Hypoglycemic Agents ➢Chose insulin sensitisers ➢Metformin-safe with modified dosage ➢Glitazones cannot be substituted ➢1st generation sulfonylureas are unsuitable ➢2nd generation sulfonylureas use with caution
  18. 18. Short-acting Insulin Secretagogues. ➢Short duration of action. ➢Twice daily before sunset & predawn meals. ➢Nateglinide has lowest risk of hypoglycemia
  19. 19. Incretin-based Therapy. ➢Not associated with hypoglycemia, ➢Exenatide can be used before meals ➢Liraglutide OD controls fasting glycemia ➢GLP-1 require titration & cause nausea ➢DPP-4 do not require titration
  20. 20. alfa-Glucosidase Inhibitors. ➢Less risk of hypoglycemia ➢Used in combination ➢Increase flatulence
  21. 21. Type II DM on Insulin. ➢Less incidence of hypoglycemia ➢Long/intermediate acting with short acting before meals ➢Rapid acting better than short acting
  22. 22. Insulin Pumps ➢Frequent glucose monitoring ➢Hypo/Hyperglycemia can be precisely controlled ➢Need education and training
  23. 23. Treatment Changes in Type II DM ➢ Diet & exercise control ➢Patients on OHA ➢Metformin 500 TID ➢TZDs/ AGIs/ incretin ➢Modified exercise with more fluids ➢Adequate fluids ➢1000 iftar -500 @sohar ➢No change
  24. 24. Treatment Changes in Type II DM ➢Sulfonylureas OD ➢Sulfonylureas BID ➢Adjusted dose before sunset meal ➢Half dose for predawn meal
  25. 25. Type II DM on Insulin ➢Patients on insulin ➢BID Premixed/ intermediate-acting ➢Adequate fluids ➢Change to long/intermediate with short acting half dose at predawn & usual dose at sunset
  26. 26. Pregnancy & fasting in Ramadan ➢High risk of morbidity & mortality to fetus & mother ➢Requires intensive care and education ➢Idealy managed in high risk clinic ➢Intensive diet and insulin therapy
  27. 27. Hypertension & Dyslipidemia ➢Prone for dehydration & hypotension ➢Need dose adjustment ➢Diuretics inappropriate ➢Avoid carbohydrate rich & saturated fat diet
  28. 28. Conclusions ➢Type I DM carry very high risk of life threatening complications ➢Limited Type II DM carry high risk of hypoglycemia ➢Pre-ramadan structured education ➢Newer agents have advantage in ramadan ➢Insulin pumps provide greater safety in ramadan ➢Need more research

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  • sayeed2002

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    Apr. 12, 2019

Management of Diabetes in Ramadan ADA 2010 guidelines


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