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Sweet Success: Managing Diabetes Through Case Studies

The month of Ramadan is an important time of spiritual reflection and observance for Muslims worldwide. However, Ramadan fasting can pose challenges for individuals with diabetes, affecting their glycemic control. There are several key risks associated with diabetes during Ramadan such as Hypoglycemia, Hyperglycemia, Diabetic ketoacidosis, dehydration, and thrombosis1.

Case Scenario- Mr. Ahmed Sheikh, a 60-year-old university professor with type 2 diabetes for 10 years, intends to fast during Ramadan. During Ramadan, he breaks fast by having a carbohydrate-rich diet leading to hyperglycemia during the evening time. His fasting period lasts up to 18 hours per day and therefore he is worried about experiencing hypoglycemia during Ramadan fasting time and is seeking guidance on how his diabetes treatment plan can be tailored to minimize this risk. The patient has an active medical history of hypertension and dyslipidemia. He is currently prescribed dapagliflozin 10 mg/day and metformin 1000 mg/day in the morning, as well as glargine U-100 16 units at night for diabetes and Telmisartan 40 mg/day for hypertension. Additionally, he is taking Atorvastatin 10 mg at night for dyslipidemia. Recent laboratory reports indicate elevated levels of HbA1c at 8.2%, fasting blood glucose at 140 mg/dL, and postprandial blood glucose at 210 mg/dL.

Q1:  What is your recommended treatment plan for the patient to effectively manage his diabetes while intermittently fasting?

References : 

  1. Shiju R, Akhil A, Thankachan S, Tuomilehto J, Al Arouj M, Bennakhi A. Safety Assessment of Glucose-Lowering Drugs and Importance of Structured Education during Ramadan: A Systematic Review and Meta-Analysis. Journal of diabetes research. 2022 Feb 18; 2022.
  2. Hassanein M, Al-Arouj M, Ben-Nakhi A, Al-Madani A, Shaltout I, Alawadi F, Afandi B, Al Twaim A, Izani WM, Salih BT, Nordin S. Management of Diabetes during Ramadan. IDF-DAR Practical Guidelines: map of contributor nationalities and country affiliations. 2016 Apr: 85.
  3. Mohamed Hassanein, Monira Al-Arouj, Osama Hamdy, Wan Mohamad Wan Bebakar, Abdul Jabbar, Abdulrazzaq Al-Madani, Wasim Hanif, Nader Lessan, Abdul Basit, Khaled Tayeb, MAK Omar, Khalifa Abdallah, Abdulaziz Al Twaim, Mehmet Akif Buyukbese, Adel A. El-Sayed, Abdullah Ben-Nakhi, Diabetes and Ramadan: Practical guidelines, Diabetes Research and Clinical Practice, Volume 126, 2017.