Diabetes mellitus: Ramadan

We know that type 2 diabetes mellitus is more common in people of Asian ethnicity and a significant proportion of those patients in the UK will be Muslim. The BMJ published an excellent and comprehensive review of this issue in 20101.

It is important that we can give appropriate advice to Muslim patients to allow them safely observe their fast. This is particularly important from 2014 as Ramadan is due to fall in the long days of the summer months for several years henceforth.

Clearly it is a personal decision whether a patient decides to fast. It may however be worthwhile exploring the fact that people with chronic conditions are exempt from fasting or may be able to delay fasting to the shorter days of the winter months. It is however known that many Muslim patients with diabetes do not class themselves as having a chronic/serious condition which should exempt them from fasting. Around 79% of Muslim patients with type 2 diabetes mellitus fast Ramadan2.There is an excellent patient information leaflet from Diabetes UK and the Muslim Council of Britain which explores these options in more detail.

• they should try and and eat a meal containing long-acting carbohydrates prior to sunrise (Suhoor)
• patients should be given a blood glucose monitor to allow them to check their glucose levels, particularly if they feel unwell
• for patients taking metformin the expert consensus is that the dose should be split one-third before sunrise (Suhoor) and two-thirds after sunset (Iftar)
• expert consensus also recommends switching once-daily sulfonylureas to after sunset. For patients taking twice-daily preparations such as gliclazide it is recommended that a larger proportion of the dose is taken after after sunset
• no adjustment is needed for patients taking pioglitazone