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Diabetes Management In Ramadan

Recommendations For Management Of Diabetes During Ramadan

Recommendations For Management Of Diabetes During Ramadan

Since our last publication about diabetes and fasting during Ramadan (1), we have received many inquires and comments concerning important issues that were not discussed in the previous document, including the voluntary 1- to 2-day fasts per week that many Muslims practice throughout the year, as well as the effect of prolonged fasting (more than 18 h a day) in regions far from the equator during Ramadan when it occurs in summer—a phenomenon expected to affect millions worldwide for the next 10–15 years. Since 2005, there have been substantial additions to the literature, including two studies examining the effect of structured education and support for safe fasting, both of which had promising results (2,3). In addition, new medications, such as the incretin-based therapies, have been introduced with less risk for hypoglycemia. According to a 2009 demographic study, Islam has 1.57 billion adherents, making up 23% of the world population of 6.8 billion, and is growing by ∼3% per year (4). Fasting during Ramadan, a holy month of Islam, is a duty for all healthy adult Muslims. The high global prevalence of type 2 diabetes—6.6% among adults age 20–79 years (5)—coupled with the results of the population-based Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, which demonstrated among 12,243 people with diabetes from 13 Islamic countries that ∼43% of patients with type 1 diabetes and ∼79% of patients with type 2 diabetes fast during Ramadan (6), lead to the estimate that worldwide more than 50 million people with diabetes fast during Ramadan. Ramadan is a lunar-based month, and its duration varies between 29 and 30 days. Muslims who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after Continue reading >>

Invited Review Diabetes And Ramadan: Practical Guidelines

Invited Review Diabetes And Ramadan: Practical Guidelines

1. Introduction Fasting during Ramadan is one of the five pillars of Islam and is obligatory for all healthy adult Muslims. Within the Muslim community, there is an intense desire to participate in fasting, even among those who are eligible for exemption. The timing of Ramadan is based on the lunar calendar (355 days per year), which means that the start of Ramadan varies from year to year. In some parts of the world, daylight can last up to 20 h in the peak of summer. Climate conditions also vary according to the date of Ramadan, with people fasting in very dry and hot weather some years. Some regions with a high Muslim population, including the Middle East, Africa and South East Asia, are expected to see the number of patients with diabetes more than double in the next 25 years [1]. The Epidemiology of Diabetes and Ramadan (EPIDIAR) study performed in 2001 found that 42.8% and 78.7% of patients with Type 1 or Type 2 diabetes mellitus (T1DM/T2DM), respectively, fasted for at least 15 days during Ramadan [2]. More recently, the CREED study reported that 94.2% of T2DM patients fasted for at least 15 days and 63.6% fasted every day [3]. For fasting Muslims, the onset of Ramadan heralds a sudden shift in meal times and sleep patterns. This has important implications for physiology, with ensuing changes in the rhythm and magnitude of fluctuations in several homeostatic and endocrine processes. Sleeping patterns are often altered during Ramadan and several circadian rhythm changes have been noted, including changes in body temperature and cortisol levels [4–7]. When fasting, insulin resistance/deficiency can lead to excessive glycogen breakdown and increased gluconeogenesis in patients with diabetes, as well as ketogenesis in patients with T1DM. As a result, the risks faci Continue reading >>

Comprehensive New Guidelines Address Diabetes And Ramadan

Comprehensive New Guidelines Address Diabetes And Ramadan

Comprehensive New Guidelines Address Diabetes and Ramadan New guidelines from the International Diabetes Federation are the most comprehensive to date to address diabetes and Ramadan, including religious as well as medical guidance. Ramadan is an annual period of fasting, prayer, and giving to charity observed by more than one billion Muslims every year. Available free on the IDF website , "Diabetes and Ramadan Practical Guidelines" was developed and written by the Diabetes and Ramadan (DAR) International Alliance , with 12 main authors and 20 coauthors from all around the world. "It is quite comprehensive, for many reasons.One of the beautiful things is it's the first to include a religious opinion," Mohamed Hassanein, MBChB, chair of the DAR alliance and senior endocrinologist at Dubai Hospital, United Arab Emirates, told Medscape Medical News. During the holy month of Ramadan, practicing Muslims fast from dawn to dusk. Depending on the time of year which varies and the geographic location, this can mean up to 20 hours of fasting a day. This year, Ramadan starts in early June. Exemptions are granted for people with health conditions such as diabetes, for whom fasting can lead to hypoglycemia, hyperglycemia, dehydration, and diabetic ketoacidosis (DKA). However, the risk is greater for some people with diabetes than others, and these new guidelines provide risk stratification as well as management guidelines for those who do choose to fast. Decision to Fast Must Be Made on Individual Basis "The decision about whether to fast should be made on an individual basis in consultation with the patient's treating physician, taking into account the severity of illness and the level of risk involved," the authors write. The number of people with diabetes in the Middle East and Continue reading >>

Diabetes Management During Ramadan

Diabetes Management During Ramadan

Azizi, F. (2015). Diabetes management during Ramadan. Journal of Fasting and Health, 3(4), 140-143. doi: 10.22038/jfh.2015.6260 Fereidoun Azizi. "Diabetes management during Ramadan". Journal of Fasting and Health, 3, 4, 2015, 140-143. doi: 10.22038/jfh.2015.6260 Azizi, F. (2015). 'Diabetes management during Ramadan', Journal of Fasting and Health, 3(4), pp. 140-143. doi: 10.22038/jfh.2015.6260 Azizi, F. Diabetes management during Ramadan. Journal of Fasting and Health, 2015; 3(4): 140-143. doi: 10.22038/jfh.2015.6260 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran The Islamic fast during the month of Ramadan is strictly observed worldwide by millions of Muslims. Ramadan is the 9th month of the Islamic lunar calendar and fasting during Ramadan is the religious duty of all healthy adult Muslims. A whole month of intermittent fasting, from dawn to dusk, every year is particular only to Islam and considering that Islam has over 1.5 billion followers worldwide, it can be assumed that a few hundreds of million people observe Ramadan fasting each year. The experience of fasting teaches Muslims self-discipline and self-restraint and enables them to empathize with those less well off, the suffering and the impoverished. Fasting is not obligatory for children, menstruating women, or the sick and travelers; pregnant and lactating women are also exempt and permitted to postpone their fasting to an appropriate time when it can be observed without it affecting their maternal obligations (1). Islamic fasting provides a unique model of intermittent fasting daily for one month. It is also distinct from regular voluntary or experimental fasting in that the faster does not drink during fasting hours. Continue reading >>

Recommendations For Diabetes Management During Ramadan

Recommendations For Diabetes Management During Ramadan

Recommendations for diabetes management during Ramadan Individuals with diabetes who fast for Ramadan need regular glucose monitoring and may need to adjust their treatment regimen, according to updated recommendations from the International Group for Diabetes and Ramadan. The recommendations were published online June 16 in BMJ Open Diabetes Research & Care. In general, patients should be instructed on the use of glucose monitoring and frequency of glucose testing [and] patients receiving insulin or insulin secretagogues should be monitored two to four times daily before, during, and after the fasting period, wrote Dr. Mahmoud Ibrahim of the Center for Diabetes Education, McDonough, Ga., and his associates. Metformin was the ideal agent for managing patients with type 2 diabetes who are undergoing prolonged fasting, as it carries a low risk of hypoglycemia and is associated with a 1%-2% reduction in hemoglobin A1c (BMJ Open Diab. Res. Care 2015, June 16 [doi: 10.1136/bmjdrc-2015-000108 ]). Similarly, thiazolidinediones are considered a useful agent for use during Ramadan because of the low risk of hypoglycemia and the effectiveness in improving glucose control. Thiazolidinedione therapy should be initiated well before the start of the fast as these agents may take up to 10-12 weeks to reach maximum effectiveness, the researchers noted. Dipeptidyl peptidase-4 (DPP4) inhibitors are another option for Ramadan fasting, as there is a low risk of hypoglycemia, and studies suggest that they are effective at improving glycemic control during fasting. However, insulin secretagogues and most sulfonylureas should be avoided or should be used with extreme caution during Ramadan fasting, the authors said, pointing to recent studies showing an increased risk of hypoglycemia during Continue reading >>

Ramadan And Diabetes Management

Ramadan And Diabetes Management

Diabetes mellitus is a disease in which the bodys ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. Ideally, in case of diabetes fasting is not allowed. However during Ramadan, if you really like to keep fast, following guidelines will help you. Lower risk Healthy individual with hba1c lower range than 7.0% and treated with oral medications. May choose to fast but observe the body changes. Moderate risk Healthy individual with hba1c lower range at 8.0% and treated with oral medications. May choose to fast but always take precautions. High risk Individuals with the complications with uncontrolled sugar control are not advice to fast. A person with type 1 diabetes, severe hypo or hyperglycemia symptoms, acute illness, intense physical labor, pregnancy, renal conditions, on dialysis. All those under high-risk category are not allowed to fast. For the good and normal blood sugar control always follow a healthy diet. Which include complex carbohydrates, high fibre food, good quality protein, healthy fats. In order to minimise adverse side effects during fasting in patients with diabetes and improve or maintain glucose control, education and discussion of glucose monitoring and treatment regimens should occur several weeks prior to Ramadan A condition of blood glucose elevation is hypoglycemia and hyperglycemia. In case hypoglycemia person feels palpitation, weakness, shakiness, dizziness, sweating, anxiety, nervousness, headache. So watch or observe for the symptoms. Recommendations for prevention of hypoglycemia during Ramadan Blood glucose monitoring. Depending on treatment regimen, monitor glucose levels daily or several times a day. Patients treated with insuli Continue reading >>

Ramadan And Diabetes

Ramadan And Diabetes

Fasting during the holy month of Ramadan is an important spiritual practice. When you have diabetes, you may be wondering how fasting will affect your diabetes. There is a lot of misinformation about diabetes and Ramadan. This handout is written to answer some of the most common questions. Does everyone have to fast? No. This is based on the Holy Quran as well as the teachings of Islamic religious scholars over centuries. The Quran states that there are groups of people who do not have to fast, especially if it puts their health at risk. This includes children, pregnant or breastfeeding women, the elderly and anyone who might make themselves ill by fasting. This also includes people with poorly controlled diabetes, people with type 1 diabetes who take insulin or type 2 on a mixed insulin regimen or those who often have very high or very low blood glucose levels. I know many people with diabetes who fast and don’t have a problem. Is it okay for me? It is true, many people with diabetes can fast safely, but each person is different. Part of the decision you will make with your doctor has to do with the kind of diabetes medicine you take. It is important to schedule an appointment 2-3 months before Ramadan to discuss how fasting might affect your diabetes. Your doctor or healthcare provider may suggest a change in your medication plan. What risks should I be aware of? These are the key risks: • Low blood glucose (or hypoglycemia) – The risk of blood glucose levels going too low is highest in people taking insulin or certain diabetes pills. Limit physical activity during fasting hours and be more active after sunset. Talk with your healthcare provider to find out if your medicine puts you at risk for low blood glucose and discuss how to prevent it. • High blood gluc Continue reading >>

Recommendations For Management Of Diabetes During Ramadan

Recommendations For Management Of Diabetes During Ramadan

It is estimated that there are 1.1–1.5 billion Muslims worldwide, comprising 18–25% of the world population (1,2). Fasting during Ramadan, a holy month of Islam, is an obligatory duty for all healthy adult Muslims. An ∼4.6% prevalence of diabetes worldwide (3) coupled with the results of the population-based Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, which showed (in 12,243 people with diabetes from 13 Islamic countries) that ∼43% of patients with type 1 diabetes and ∼79% of patients with type 2 diabetes fast during Ramadan (4), lead to the estimation that some 40–50 million people with diabetes worldwide fast during Ramadan. Ramadan is a lunar-based month, and its duration varies between 29 and 30 days. Its timing changes with respect to seasons. Depending on the geographical location and season, the duration of the daily fast may range from a few to more than 20 h. Muslims who fast during Ramadan must abstain from eating, drinking, use of oral medications, and smoking from predawn to after sunset; however, there are no restrictions on food or fluid intake between sunset and dawn. Most people consume two meals per day during this month, one after sunset, referred to in Arabic as Iftar (breaking of the fast meal), and the other before dawn, referred to as Suhur (predawn). Fasting is not meant to create excessive hardship on the Muslim individual. The Koran specifically exempts the sick from the duty of fasting (Holy Koran, Al-Bakarah, 183–185), especially if fasting might lead to harmful consequences for the individual. Patients with diabetes fall under this category because their chronic metabolic disorder may place them at high risk for various complications if the pattern and amount of their meal and fluid intake is markedly altered Continue reading >>

Management Of Diabetes During Ramadan

Management Of Diabetes During Ramadan

This course is available for purchase as part of a subscription: Professor Rayaz Malik and colleagues explain how to advise Muslim patients with diabetes on fasting safely during Ramadan. Key learning points include advice to give on diet and on adjusting insulin and other diabetes therapy, including newer antidiabetic agents, during this period. The article also highlights the additional cardiovascular risks faced by South Asians with diabetes. After reading this activity, GPs and other healthcare professionals will be better able to: Understand the importance of fasting during Ramadan for Muslim patients Advise patients with diabetes who fast about how to do so safely Advise patients how to manage their diabetes medication during fasting Understand the additional cardiovascular risks for South Asians with diabetes Manchester Royal Infirmary and University of Manchester Manchester Royal Infirmary and University of Manchester Professor of medicine, Weill Cornell Medicine Manchester Royal Infirmary and University of Manchester Professor of medicine, Weill Cornell Medicine Manchester Royal Infirmary and University of Manchester This is a learning activity provided by MIMS Learning, featuring learning material and a test. Completing the test enables you to claim 0.5 learning credits (0.5 hours learning). This credit award is recommended by MIMS Learning based on completing the activity and reflecting on what you have learned. If you spend less time on the activity we recommend claiming fewer credits. Please proceed with the activity until you have successfully answered all the test questions and completed your evaluation. You will then receive your MIMS Learning CPD certificate, which will be added to your CPD organiser for access at any time and may be exported to the Cl Continue reading >>

Diabetes & Ramadan: Top 3 Things To Watch Out For

Diabetes & Ramadan: Top 3 Things To Watch Out For

Ramadan has just begun, marking a period of fasting and religious focus for millions of Muslims around the world. For those participating, remember to talk to your healthcare provider about your diabetes and make sure that fasting is a safe option for you. You might need to modify your exercise, diet and medication routines to keep your blood sugars in range during this time of year. Top 3 Things to Watch Out for During Ramadan 1. Low blood glucose (hypoglycemia) The risk of blood glucose levels going too low is greatest in people taking insulin or certain diabetes pills. Limit physical activity during fasting hours and be more active after sunset. Talk with your healthcare provider to find out if your medicine puts you at risk for low blood glucose and discuss how to prevent it. SYMPTOMS INCLUDE: shakiness, heart racing, sweats/chills, intense hunger, numbness/tingling, drowsiness, blurry vision, dizziness, difficulty concentrating, confusion, anxiety, nausea, and headache 2. High blood glucose (hyperglycemia) While low blood glucose levels may happen during the day, after the fast is broken, there is a greater risk to overeat. Watch out for eating too many sweets and keep the portion sizes moderate. Even though Ramadan is known as a time of fasting, it is not uncommon for people to gain weight during this month, as in some families, every evening meal is a celebration. SYMPTOMS INCLUDE: Dry mouth, increased thirst, hunger, fatigue (weak, tired feeling), nausea and vomiting, abdominal pain, shortness of breath, fruity-smelling breath, blurry vision, headache, dizziness 3. Dehydration This is especially a problem during the longer and hotter summer days. Aim to drink lots of water and sugar-free and caffeine-free drinks frequently throughout the evening and before dawn Continue reading >>

Guidelines

Guidelines

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. Diabetes and Ramadan: Practical Guidelines Ensuring the optimal care of the many people with diabetes who fast during Ramadan is crucial. The International Diabetes Federation (IDF) and the Diabetes and Ramadan (DAR) International Alliance have therefore come together to deliver comprehensive guidance on this subject. The IDF-DAR Practical Guidelines provide healthcare professionals (HCPs) with relevant background information and practical recommendations to enable them to help people with diabetes participate in fasting during Ramadan while minimising the risk of complications. Download Continue reading >>

Ramadan And Diabetes: Guide To Diabetes Management During Ramadan

Ramadan And Diabetes: Guide To Diabetes Management During Ramadan

Ramadan is a lunar month, which is coming in a few weeks as I am writing this article. During this month Muslims fast by avoiding any kind of eating or drinking as well as medications or smoking for certain hours every day. Fasting has many effects on the body and its physiology, which requires good understanding of these changes and the effect they have on diabetic patients. According to the EPIDIAR(Epidemiology of Diabetes and Ramadan) study on 12,243 Muslims from 13 different countries, approximately 43% of Type 1 Diabetes patients and 79% of Type 2 Diabetes patients fast every year during Ramadan. Diabetes and Ramadan Guidelines In this article we will go through the changes in the body and pathophysiology of the body during Ramadan, as well as the changes and guidelines that should be taken into consideration by diabetic patients during the month of Ramadan. Pathophysiology of Fasting In healthy individuals, feeding promotes the secretion of insulin (a hormone secreted from the pancreas), which is responsible for the storage of glucose sugar in muscles and liver as glycogen. Levels of Insulin tend to decrease during fasting as a result of the decreased glucose levels. On the other hand, levels of catecholamines and glucagon are increased, which stimulates glycogen degradation. After several hours of fasting, the stores of glycogen are depleted, and increased levels of fatty acid are released from fat cells as a result of the low circulating levels of insulin. According to a study by Felig, the transition from a fed state to a fasted state is mediated by several hormonal, glucoregulatory, and metabolic mechanisms, which can be divided into three stages: Postabsorptive phase, which lasts from 6 to 24 hours after the beginning of fasting Gluconeogenic phase, which las Continue reading >>

Physician Awareness In Diabetes Management During Ramadan 2015a Focus Group Discussion

Physician Awareness In Diabetes Management During Ramadan 2015a Focus Group Discussion

Physician Awareness in Diabetes Management During Ramadan 2015A Focus Group Discussion US Endocrinology, 2017;13(1):304 DOI: Background: Diabetic Muslims who wish to fast are recommended to undergo medical counseling prior to fasting to prevent complications. This study assesses knowledge, attitudes, and practices, and identifies issues related to building capacity for physicians treating diabetic patients. Methods: We conducted a qualitative study based on focus group discussions with primary healthcare center (PHCC) doctors who manage diabetic patients in the Riyadh region. Results: There is a lack of knowledge of the classification system for risk assessment of diabetic patients who fast during Ramadan. All the responses showed that there were misconceptions regarding nitroglycerin tablets placed under the tongue to nullify fasting. Other issues addressed by respondents include the following: how to adjust the dose and subsequently convince the patient to follow a new regimen, loss of patient follow-up due to referral to the hospital, the refusal of some laboratories to perform examinations for patients referred from other PHCCs, and lack of patient medication compliance. Conclusion: The study reported a lack of knowledge among respondents regarding therapeutic and lifestyle management of diabetic patients during Ramadan. Other issues addressed by participants include lack of healthcare services at primary healthcare center facilities and services not working effectively. To empower physicians and improve knowledge, attitude, and practices for managing diabetic patients during Ramadan, experience, continuous training, as well as fully equipped healthcare centers (including both laboratory and pharmaceutical medical supplies) play a crucial role. Keywords: Diabetes, Continue reading >>

Apollo Sugar Organizes Diabetes Management Workshops For The Ramadan Season

Apollo Sugar Organizes Diabetes Management Workshops For The Ramadan Season

Apollo Sugar organizes diabetes management workshops for the Ramadan season Apollo Sugar organizes diabetes management workshops for the Ramadan season India Infoline News Service | Mumbai | June 30, 2016 15:41 IST The activity is also taking place in Hyderabad, Chennai, Mumbai, Raipur and Bhubaneswar. Article saved successfully to my page. You must be Logged in to save article. A+ a- 0 Open FREE Demat Account and get access to indepth research on 500 stocks By clicking on submit button, you authorize IIFL & its representatives & agents to provide information about various products, offers and services provided by IIFL through any mode including telephone calls, SMS, letters etc. . you confirm that laws in relation to unsolicited communication referred in National Do Not Call Registry as laid down by Telecom Regulatory Authority of India will not be applicable for such information/ communication. To educate diabetic patients and their families on healthy and safe fasting practices, Apollo Sugar- an innovative, single-specialty diabetes and endocrine healthcare provider, is approaching all the mosques near the clinic and organising a Ramadan Diabetes Camp in Frazer Town, Banashankari and JP Nagar. The activity is also taking place in Hyderabad, Chennai, Mumbai, Raipur and Bhubaneswar. The informative session, conducted by a team of doctors and dietitians will include free health screenings. Out of the 44 camps conducted by Apollo Sugar, out of which 40% of people were found to have good diabetic control while the remaining were diagnosed with extremely poor control of the disease. Speaking about the initiative, Mr. Gagan Bhalla, CEO, Apollo Sugar said, Apollo Sugar is committed to providing superior quality health care services to address the day-to-day health care need Continue reading >>

Muslims Advised About Safe Diabetes Management Through Ramadan

Muslims Advised About Safe Diabetes Management Through Ramadan

Muslims advised about safe diabetes management through Ramadan Muslims advised about safe diabetes management through Ramadan High-fat, low-carb diet reduces HbA1c, weight and medication in US study 28 March 2017 People with diabetes who are observing Ramadan are being reminded how to best manage their condition during the fasting process. The holy period, which began on Friday, 26 May, involves practising Muslims going without food for more than 17 hours a day. Ramadan draws to a close in the UK on Sunday, 25 June. People are being reminded how important it is to monitor their blood sugar levels regularly to avoid periods of too high or too low blood sugar levels . Unless you are underweight, or close to being underweight, it is best to avoid overeating at Suhoor and Iftar, the meals before and after fasting . Although it can be tempting, eating large quantities of food is likely to result in too high blood glucose levels at least initially and could lead to weight gain despite the fasting period in between. Speak to your doctor if you need help with managing your food intake through Ramadan. Hypoglycemia can develop in people that are on insulin or classes of tablets known as sulphonylureas or glinides. Ask your doctor if you need to know whether your tablets can cause hypos (too low blood sugar levels). Avoiding drinking for long periods of time can put people with diabetes at risk of dehydration . The risk is increased further if blood sugar levels are on the high side. Although the Qur'an states fasting is necessary in a bid to promote chastity and humility for Allah, people who are unwell or pregnant are exempt from taking part. Should people with diabetes wish to pursue the fasting process it is highly recommended they speak to their diabetes healthcare team fir Continue reading >>

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