Intensified insulin therapy during fasting of Ramadan in type 1 diabetic patients

Evaluate safety of insulin glargine/aspart regimen in type 1 diabetics who are willing to fast Ramadan. Thirty-three patients with type 1 diabetes (mean age ± SD; 21.9 ± 8.7 years) were included. One week before the study, clinical and laboratory evaluations were undertaken. Patients on basal/bolus insulin had their doses adjusted. Those with another insulin regimen were changed to glargine/aspart regimen with adjustment of doses. At the beginning of Ramadan, patients were shifted to glargine once-daily and aspart before Iftar (sunset-meal), Suhur (sunrise-meal) and a meal in between. Total dose was reduced to 90% of pre-Ramadan dose. Patients were instructed to report any hypoglycemia, severe hyperglycemia or ketosis, and their self-monitored plasma glucose at five planned visits in Ramadan. All clinical and laboratory evaluations were repeated at the end-of-Ramadan. At the end of Ramadan, there was no report of severe hypoglycemia, hyperglycemia or diabetic ketoacidosis. Twenty patients suffered 70 hypoglycemia events; one discontinued fasting in 2 days. There was no significant change in HbA1c (p = 0.373) between pre-Ramadan (Mean ± SD; 6.5 ± 1.2%) and end-of-Ramadan level (Mean ± SD; 6.9 ± 1.2%). Moreover, there was no significant change (p = 0.251) in fructosamine level between pre-Ramadan (2.8 ± 0.9 mol/L) and end-of-Ramadan (3.2 ± 1.1 mol/L). Insulin dose had increased by 7% of the starting dose (p = 0.0496). There was no significant (p > 0.05) change in weight, BMI and lipid profile at the end–of-Ramadan. Patients with type 1 diabetes can fast Ramadan safely, using low-peak basal insulin and rapid-acting pre-meal insulin, under strict blood glucose-monitoring and close supervision.