Diabetes and Ramadan (DaR)

Diabetes and Ramadan


Sudan Diabetes Association(SUDA)


Patients with diabetes who wish to fast Ramadan may be grouped into 3 risk catogeries:

Category 1(High risk):

1- Severe hypoglycemia within 3 months prior to Ramadan.

2- DKA within 3 months prior to Ramadan.

3- Hyperosmolar hyperglycemia within 3 months prior to Ramadan.

4- Recurrent hypoglycemia or hypoglycemia unawareness.

5- Persistent poor glycemic control or HbA1c 9%.

6- Patients with type 1 DM.

7- Patients with advanced macro- vascular complications.

8- Pregnancy.

9- Patients with renal insufficiency or in dialysis.

10- Patients with co-morbid conditions that present additional risk factors.

11- Acute illness.

12- Intense physical labor.

13- Patients living alone and are treated with insulin or sulphonylureas.

14- Elderly patients with ill healthor patients who take drugs that affect cognition.


Recommended Changes of Treatment Regimens


Patients, on Insulin, who are Planning to Fast Ramadan

Before Ramadan During Ramadan
Premixed insulin BD (e.g. 30U am / 20 U pm) Same am dose at Iftar, but 50% of pm dose at Sahoor (30 U/ 10U)
Short acting; usually TDS Same dose at Ifta, omit afternoon dose and give 25- 50%of the evening dose at Sahoor
NPH, Detemer, Glargine (Lantus), Dugledec OD Reduce the dose by 15- 30% at Iftar
NPH,Detemer BD Same usual dose at Iftar and reduce evening dose by 50% to be taken at Sahoor


 Caregory 2(MODERATE RISK)

1- Well controlled Type 2 DM treated with SU or SGLT2 inhibitors.

2- Well controlled Type 2 DM treated with insulin.

Category 3 (LOW RISK)

1- Well- controlled Type 2 DM treated with life- style therapy,Acarbose, Melformin, Thiazolidinedione, DPP-41, GLP agonist or basal insulin.

  • Category 1: advised not to fast
  • Category 2: depends on doctors advice and patients wish
  • Category 3: May fast

Patients may change from one category to another.


Recommended Changes of Treatment Regimens


Patients, on Oral Anti-diabetic Agents,who are Planning to Fast Rmadan

Before Ramadan During Ramadan
Metformin 500/850/1000 mg OD Same dose with Iftar
Metformin 500 mg TDS 1 gm with Iftar and 500 mg with sahoor
Pioglitazone OD am Same dose with Iftar
SU (glicazide, glimipride)

OD: Same dose with Iftar

BH: am dose with Iftar and half evening dose with sahoor

SU / Glibemclamide Discontinue Glibemclamide. Change to shorter acting SU with low risk of hypoglycemia
DPP4-1GLP-1 agonist SGLT2-1

OD:  Same dose with Iftar

BD: am dose with Iftar and evening dose with sahoor




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