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Insulin During Fasting

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 >>

Intermittent Fasting: Surprising Update

Intermittent Fasting: Surprising Update

Theres a ton of incredibly promising intermittent fasting (IF) research done on fat rats. They lose weight, their blood pressure, cholesterol, and blood sugars improve but theyre rats. Studies in humans, almost across the board, have shown that IF is safe and incredibly effective, but really no more effective than any other diet. In addition, many people find it difficult to fast. But a growing body of research suggests that the timing of the fast is key, and can make IF a more realistic, sustainable, and effective approach for weight loss, as well as for diabetes prevention. IF as a weight loss approach has been around in various forms for ages, but was highly popularized in 2012 by BBC broadcast journalist Dr. Michael Mosleys TV documentary Eat Fast, Live Longer and book The Fast Diet, followed by journalist Kate Harrisons book The 5:2 Diet based on her own experience, and subsequently by Dr. Jason Fungs 2016 bestseller The Obesity Code. IF generated a steady positive buzz as anecdotes of its effectiveness proliferated. As a lifestyle-leaning research doctor, I needed to understand the science. The Obesity Code seemed the most evidence-based summary resource, and I loved it. Fung successfully combines plenty of research, his clinical experience, and sensible nutrition advice, and also addresses the socioeconomic forces conspiring to make us fat. He is very clear that we should eat more fruits and veggies, fiber, healthy protein, and fats, and avoid sugar, refined grains, processed foods, and for Gods sake, stop snacking. Check, check, check, I agree. The only part that was still questionable in my mind was the intermittent fasting part. Intermittent fasting can help weight loss IF makes intuitive sense. The food we eat is broken down by enzymes in our gut and eventua Continue reading >>

Reverse Insulin Resistance With Intermittent Fasting

Reverse Insulin Resistance With Intermittent Fasting

Reverse Insulin Resistance with Intermittent Fasting Intermittent fasting is the best insulin resistance diet to help your cells respond to insulin. When your body gets the signal that youve eaten, beta cells in your pancreas produce insulin, a hormone that tells your cells to absorb glucose to use as fuel. Your cells respond by receiving the glucose from your bloodstream. This gives you the energy you need, and you dont pack on body fat. But sometimes, this communication gets thrown off. Insulin resistance is when insulin tells your cells that fuel is coming, but they dont open up to receive glucose. So, sugar stays in the bloodstream, and after a while your body stores it as fat. Read on to find out how intermittent fasting can fix insulin resistance. Heres a scenario. Youre hungry. Because youre hungry, youre annoyed with everything. You might even recognize that your blood sugar just dropped and you need to eat something. There are a couple things behind this: your blood sugar, your insulin, and how well your cells follow directions. When you eat and your body breaks down your food, the glucose (sugar) from your food goes into your bloodstream for transport to your cells. Glucose gives your cells the fuel they need to do their jobs. Insulin is a hormone that tells your cells to accept their delivery of glucose fuel. When your body gets the signal that youve eaten, beta cells in your pancreas produce insulin, which is what tells your cells absorb glucose. When you dont have insulin, such as when you have diabetes (more on this later), your cells do not allow glucose in and the glucose stays in your bloodstream. Once your body senses that glucose has been hanging around in your bloodstream for a while, it stores it as fat for later, because it thinks your cells dont Continue reading >>

The Sweet Spot For Intermittent Fasting

The Sweet Spot For Intermittent Fasting

The Sweet Spot for Intermittent Fasting Lower insulin means greater fat loss Intermittent fasting — the practice of going without food for some (undefined) period of time — has many health benefits. It can help prevent heart disease, speed fat loss, and slow or reverse aging. There are a number of physiological mechanisms involved. It reduces inflammation and oxidative stress, leads to increased numbers and quality of mitochondria, and increases autophagy, the cellular self-cleansing process. Many of the beneficial effects are entwined with lower levels of insulin. The function of insulin is to promote energy storage and the growth of the organism. When insulin is increased, fat is stored in fat cells, and other cells take up glucose from the blood. Most importantly, when insulin is increased, lipids can’t leave fat cells. Since fat loss is all about getting lipids out of fat cells to be burned, losing fat requires some attention to how diet, exercise, and fasting cause insulin to rise or fall. Take a look at the following graph, taken from a paper by Volek et al. It shows that even small increases in insulin, within the normal range, virtually abolish lipolysis, or the breakdown of fat. This is where intermittent fasting comes in, as one of its effects is to lower insulin levels and thus increase lipolysis. The question is, how long do you need to fast before insulin comes down? Eating causes insulin to rise, the amount of the rise being dependent on a number of factors, such as type and amount of food eaten and the insulin sensitivity of the person doing the eating. High amounts of carbohydrates and lower insulin sensitivity cause a greater rise in insulin. Insulin increases and stays higher for several hours after eating — that is, during the “fed” state. Continue reading >>

What Does Fasting Do To Insulin?

What Does Fasting Do To Insulin?

A common thread among many dietary plans is compressing eating times. On the one hand, some plans narrow periods to two to three meals per day, with substantial time gaps in between (i.e. time-restricted feeding). Variation include other strategies that suggest eating normally for a few days, then avoiding food entirely for a few days (i.e. intermittent fasting). On the other hand, some diet plans encourage eating several meals throughout the day (i.e, “grazing”; 6-8 small meals per day). Because elevated insulin is one of the most, if not the most, relevant factor in developing insulin resistance, a highly rational strategy is to follow a dietary plan that incorporates periods of time throughout the day wherein insulin is low. This philosophy immediately suggests that frequent eating is less effective than less frequent eating—indeed, three meals per day is better than six [1]—but are fewer than three meals best of all? Maybe. Fasting’s Effectiveness Partially Depends on How It’s Done Time-restricted feeding and intermittent fasting strategically include periods of deliberate food avoidance. The evidence regarding its efficacy in improving insulin sensitivity is valid, though it partially depends on how it’s done. Two studies used this idea by having study subjects eat normally one day (i.e. unrestricted) and essentially fast the entire second day (i.e., alternate-day fasting), repeated seven times over a two-week period and found conflicting results—one reporting an improvement in insulin sensitivity [2], while the other observed no benefit [3]. An alternative strategy, wherein the person confines eating to a specific window of time each day (e.g., eating breakfast and dinner only [4], or lunch and dinner only [5]) yielded robust improvements in insuli Continue reading >>

South Asian Consensus Guideline: Use Of Insulin In Diabetes During Ramadan

South Asian Consensus Guideline: Use Of Insulin In Diabetes During Ramadan

South Asian Consensus Guideline: Use of insulin in diabetes during Ramadan Department of Endocrinology, BIRDEM, Dhaka, Bangladesh 1Department of Endocrinology, Osmania Medical College, Hyderabad, India 2Department of Endocrinology, Advanced Center for Diabetes and Endocrine Care, Srinagar, India 3Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan 4President, Diabetic Association of Bangladesh, Bangladesh 5Department of Endocrinology, AIIMS, New Delhi, India 6Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh 7Department of Endocrinology, Shifa International Hospital, Islamabad, Pakistan 8Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India Corresponding Author: Prof. Md Faruque Pathan, Department of Endocrinology, BIRDEM, Dhaka, Bangladesh. E-mail: [email protected] Copyright : Indian Journal of Endocrinology and Metabolism This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. A person with diabetes mellitus (DM) has every right to perform the ritual of fasting during Ramadan. In daily practice we come across both type 1 and type 2 DM who wish to fast. This Consensus Statement describes the pre-Ramadan assessment, planning, prescription, management, and monitoring of patients on insulin, who wish to fast. Keywords: Aspart, basal insulin, detemir, glargine, lispro, premixed insulin, regular insulin, type 1 diabetes, type 2 diabetes Fasting during Ramadan is one of the principal rituals and prayers for the Muslim. Continue reading >>

Can A Diabetic Take Insulin While Fasting?

Can A Diabetic Take Insulin While Fasting?

Wa `alaykum as-salamu wa rahmatullahi wa barakatuh. In the Name of Allah, Most Gracious, Most Merciful. All praise and thanks are due to Allah, and peace and blessings be upon His Messenger. In this fatwa: As for your question, your mother may take the insulin injection while fasting; it doesn’t break the fast. However, if her fasting will harm her—according to her reliable physicians—she is then allowed not to fast and expiate for missing the fast days of Ramadan. Responding to your question, Dr. Hatem Al-Hajj, Dean of Shari`ah Academy of America, stated: Firstly, should a diabetic fast? This depends on the severity of the disease. The patient should see a trustworthy Muslim physician and ask him if fasting for his/her particular case would be harmful. If no Muslim physicians are within reach, then, I would recommend asking two non-Muslim physicians that he would trust. If they agree that it would harm him/her to fast, then he/she is entitled to the concession of breaking the fast. In this case, he or she will only need to expiate by feeding a poor person one meal per each day he does not fast. Secondly, if your mother decides to fast, then she may get her insulin shots while fasting; injections do not invalidate fasting unless they are nutritious. This is the fatwa of the Islamic Fiqh Assembly of the Organization of the Islamic Conference (OIC) Decision Number: 93 (10/1). Session Venue: Jeddah, Kingdom of Saudi Arabia. Session Date: Safar 23rd – 28th, 1418 A.H. / June 28th – July 3rd, 1997 C.E. Allah Almighty knows best. Continue reading >>

Recommendations For Insulin Using Patients When Fasting

Recommendations For Insulin Using Patients When Fasting

Can patients who use insulin safely fast? The topic of fasting comes up often as patients may have to fast for laboratory tests, surgery, diagnostic procedures (e.g. colonoscopy), or religious reasons, or just to improve their blood sugars or lose weight. It can be a major challenge for just about anyone but can be particularly difficult for patients with insulin-dependent diabetes. Patients with insulin-dependent diabetes need to understand the management of diabetes during fasting to prevent hypoglycemia (blood glucose < 70 mg/mL or 3.9 mmol/L). Plus, the duration of the fast affects how much insulin is needed during that time. The management of people with diabetes who fast is mostly based on expert opinion rather than medical evidence gained from clinical studies. For patients using insulin who want to fast, there may need to be extra attention since healthcare professionals (HCPs) who are not experienced in dealing with fasting people with diabetes might not consult or even be aware of published recommendations [4]. Evidence-based guidelines are important and, although the evidence available in this area continues to increase, more randomized controlled trials are needed to fully answer questions related to controlling blood sugars when fasting. One of the best examples of large numbers of people fasting is for Muslims during Ramadan, who fast from 15 to 30 days.[7] People with T1DM will be advised not to fast because of the risks of severe complications. However, recent studies involving young adults suggest that if the patient is stable, otherwise healthy, has good hypoglycemic awareness and complies with their individualized management plan under medical supervision, then many of these patients can fast safely. One study involving 33 adolescent children with T1D Continue reading >>

Diabetes Fasting And Insulin

Diabetes Fasting And Insulin

Your doctor has suggested you have a test that requires you to fast before the test. This means you will not eat food or drink liquids for a period of time before the test. If you have diabetes and take Insulin this Test Facts will help you fast and control your blood sugar (glucose) levels. If, after reading this information you are still unsure as to how to dose your insulin, check with the doctor who prescribes your insulin for advice. Mealtime (Short-Acting) Insulin )Humalog®, NovoLog®, Apidra®, Humulin® R, Novolin® R) Do not take these insulin’s on the day of the fast. Start again when you are eating meals. Long-Acting Insulin (Lantus®, Levemir®, NPH) If you usually take Lantus, Levemir, or NPH in the morning, take half dose on the morning of the fasting day. If you usually take Lantus, Levemir, or NPH at bedtime, take all of your usual dose the night before the fasting day. If you usually take Lantus, Levemir, or NPH at bedtime, take all of your usual dose at the usual time AFTER the fasting is over. Insulin Pumps Insulin pump users should not take bolus insulin on the day of the fast, but should continue their basal rate. The basal rate should continue unchanged on the day of the fast. If you are worried that the basal insulin will cause low blood sugar, adjust the basal rate to 80% of the usual rate for the day of the fast. Mixed Insulins (70/30 mix, 75/25 mix, 50/50 mix) A general rule is to just use HALF doses on the day of the fast. Treating Low Blood Sugar While Fasting While fasting, check your blood sugar four times a day (at your usual mealtimes and at bedtime) or anytime you have symptoms of a low blood sugar. Common symptoms of a low blood sugar may include: shakiness, dizziness, sweating and headache. If your blood sugar drops under 70, you sh Continue reading >>

You Are “when” You Eat: The Benefits Of Intermittent Fasting (video)

You Are “when” You Eat: The Benefits Of Intermittent Fasting (video)

Intermittent fasting is term coined by the research world that refers to an extended duration of minimal calorie intake. Believe it or not, humans are evolutionarily adapted to performing intermittent fasts – our ancestors performed extended fasts whenever food was unavailable, and feasted only when they could procure enough food to eat. However, in our modern world of abundance, deliberately fasting for an extended period of time is anything but “normal.” Fasting goes against every morsel of modern life, and is in direct opposition to the abundance-based food culture that we have worked so hard to create. In our world of fast food, on-demand food delivery and 24-hour convenience stores, choosing not to eat food can seem strange indeed. I spent my entire graduate career investigating the effects of intermittent fasting in rodents, in order to understand why calorie restriction and intermittent fasting are the gold standards for improving insulin sensitivity. As a result of this active body of research, tens of thousands of people across the world engage in intermittent fasting on a weekly basis, as a means of improving their body composition, losing fat mass, shedding pounds or observing a religious holiday. The research world has taken a large interest in calorie restriction and intermittent fasting, for the explicit purpose of identifying cellular mechanisms that may retard the aging process and promote excellent metabolic health. And in the process of studying intermittent fasting, researchers have uncovered a laundry list of health benefits that confuse even the most educated professors. The truth is that humans have been fasting for thousands of years. Modern research is playing catch-up, in order to understand why the health benefits are so impressive. The M Continue reading >>

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 >>

Fasting Recommendations For Patients With Insulin-dependent Diabetes

Fasting Recommendations For Patients With Insulin-dependent Diabetes

Can patients with insulin-dependent diabetes safely fast for medical or religious reasons? Response from Andrea G. Scott, PharmD, MPH Pharmacist, StoneSprings Hospital Center, Dulles, Virginia Fasting is a challenge for all patients but can be particularly difficult for patients with insulin-dependent diabetes. Patients may have to fast for laboratory tests, surgery, diagnostic procedures (eg, colonoscopy), or religious reasons. The duration of the fast is also important because it can affect how much insulin a patient will need during that time. Patients with insulin-dependent diabetes need to understand the management of diabetes during fasting to prevent hypoglycemia (blood glucose < 70 mg/mL or 3.9 mmol/L). Not eating for an extended period of time leads to decreased blood glucose in all patients. In patients without diabetes, insulin levels decrease as glucagon increases, and the act of glycogenolysis provides about 75% of glucose requirements.[ 1 ] This mechanism allows blood glucose levels to remain within a normal range. In patients with insulin-dependent diabetes, the glucagon response is lost, and epinephrine becomes the main method to increase gluconeogenesis in the liver. However, the epinephrine response also diminishes over time; thus, patients with insulin-dependent diabetes are at risk for hypoglycemia.[ 2 ] Symptoms of hypoglycemia include sweating, shaking, mood changes, hunger, headache, tachycardia, and, in severe cases, unconsciousness, seizures, and coma.[ 2 ] Healthcare professionals should discuss the symptoms of hypoglycemia with patients who are planning to fast. The duration of the fast and the type of insulin used can help guide insulin treatment during the fasting period. Some minor adjustments to insulin may be required if patients are fas Continue reading >>

Fasting Physiology – Part Ii

Fasting Physiology – Part Ii

There are many misconceptions about fasting. It is useful to review the physiology of what happens to our body when we eat nothing. Physiology Glucose and fat are the body’s main sources of energy. If glucose is not available, then the body will adjust by using fat, without any detrimental health effects. This is simply a natural part of life. Periods of low food availability have always been a part of human history. Mechanisms have evolved to adapt to this fact of Paleolithic life. The transition from the fed state to the fasted state occurs in several stages. Feeding – During meals, insulin levels are raised. This allows uptake of glucose into tissues such as the muscle or brain to be used directly for energy. Excess glucose is stored as glycogen in the liver. The post-absorptive phase – 6-24 hours after beginning fasting. Insulin levels start to fall. Breakdown of glycogen releases glucose for energy. Glycogen stores last for roughly 24 hours. Gluconeogenesis – 24 hours to 2 days – The liver manufactures new glucose from amino acids in a process called “gluconeogenesis”. Literally, this is translated as “making new glucose”. In non-diabetic persons, glucose levels fall but stay within the normal range. Ketosis – 2-3 days after beginning fasting – The low levels of insulin reached during fasting stimulate lipolysis, the breakdown of fat for energy. The storage form of fat, known as triglycerides, is broken into the glycerol backbone and three fatty acid chains. Glycerol is used for gluconeogenesis. Fatty acids may be used for directly for energy by many tissues in the body, but not the brain. Ketone bodies, capable of crossing the blood-brain barrier, are produced from fatty acids for use by the brain. After four days of fasting, approximately 75 Continue reading >>

Understanding Your Lab Work: Fasting Insulin Test

Understanding Your Lab Work: Fasting Insulin Test

Understanding Your Lab Work: Fasting Insulin Test Diabetes, Type 2 diabetes, pre-diabetes and blood sugar issues like metabolic syndrome, hypoglycemia and obesity are epidemic across the world. And while it can be easy to blame the victims for their own conditions (she eats too much sugar, he never exercises, etc.) this epidemic is indicative of a larger issue: standard medical tests are failing to detect the root causes of blood sugar issues before they become full-blown conditions. Type 2 Diabetes, for example, doesnt develop over the course of days or a couple weeks or even months. It typically starts with a condition called insulin resistance, which can take years and years to show up on standard blood sugar tests; at which point youd get diagnosed with pre or Type 2 Diabetes At kNew Health, our mission to help you catch the early signs of chronic health issueslike diabetesbefore they become diagnosable health hazards. Enter the Fasting Insulin Testone of the most important tests for predicting future blood sugar issues The Fasting Insulin Test is truly one of the simplest, most affordable and most accurate tests available to detect a trend toward pre-diabetes. We call it the pre-pre-diabetes test, because it measures your insulin levels, which typically becomes imbalanced long before glucose or HbA1C levels. Heres how that works: most doctors screen patients for diabetes with the fasting glucose test. If that test comes back normal, which it so often does, they tell you youre good-to-go. But the truth is, your body in its infinite wisdom, will often compensate for blood sugar issues by raising insulin levels to keep your blood glucose and HbA1c in-check. So when your doctor runs that fasting glucose test and everything looks fine, in reality you could be trending Continue reading >>

Safe Fasting With Diabetes

Safe Fasting With Diabetes

Whether you are honoring an ancient religious practice or heading to the lab for a fasting blood test, care is needed when missing meals with diabetes. Fasting can throw off the delicate balance of food, water, and blood glucose levels in potentially harmful ways. Fasting with diabetes poses significant risks, says Kathaleen Briggs Early, PhD, RD, CDE, of the Pacific Northwest University of Health Sciences. Most of the research on fasting and diabetes surrounds Ramadan, the annual Islamic observance that requires fasting from sunrise to sundown for 29 or 30 days. A commentary published in 2010 in Diabetes Care developed in collaboration with the American Diabetes Association (ADA) focused on fasting during Ramadan, though many of the issues it raises are relevant to other types of fasting as well. It says that “most often, the medical recommendation will be not to undertake fasting” if you have diabetes. The paper acknowledges that fasting for spiritual reasons is a personal decision, but one that should include the guidance of a health care provider. A study found that 43 percent of people with type 1 diabetes and 79 percent of people with type 2 diabetes from 13 Islamic countries fast during Ramadan. With that reality, fasting safely becomes a priority for people with diabetes and their care providers. “Anybody with diabetes needs to first talk to their doctor about going on a fast,” says Early, and some experts recommend a pre-fasting medical assessment to help ensure safety. If you are considering fasting, talk to your health care provider about a plan that takes medication, nutrition, and hydration into account. Regularly monitoring blood glucose during fasting is key to avoiding health emergencies. Not eating when taking insulin or certain other diabetes Continue reading >>

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