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Does Reducing Basal Insulin During Ramadan Fasting by Children and Adolescents with Type 1 Diabetes Decrease the Risk of Symptomatic Hypoglycemia?
Diabetes Technol Ther. 2016 09; 18(9):539-42.DT

Abstract

BACKGROUND

Ramadan fasting by patients with type 1 diabetes might predispose them to hypoglycemia. There are no data on the optimal way of adjusting basal insulin during fasting. We aim at studying whether reducing basal insulin during Ramadan reduces the frequency of symptomatic hypoglycemia.

METHODS

We enrolled children and adolescents with type 1 diabetes who intended to fast during Ramadan. Logbooks were given to subjects to mark days fasted, symptomatic hypoglycemia, and dose of basal insulin on all days of Ramadan. Logbooks were examined. Glucometers and insulin pumps were downloaded.

RESULTS

Seventy-five patients were enrolled. The age was 10.2-18.9 (14.5) years. Sixty-eight patients had results analyzed. Forty-one patients were on pumps, and 27 patients were on multiple daily injections (MDI). Mean HbA1c was 7.9 (1.2) and 8.4 (1.3) for the pump and the MDI, respectively (P = 0.007). Thirty-nine patients had hypoglycemia leading to breaking fast. The mean number of episodes of breaking fast was 3 (1-8). Thirty-five of the 68 patients had reduced basal insulin. The difference in the frequency of hypoglycemia in those who reduced/did not reduce insulin was not statistically significant (P > 0.10). Fifteen patients on MDI and 24 patients on pumps had at least one episode of breaking fast. Six and 18 of the patients on MDI and pumps, respectively, reduced basal insulin (P > 0.10).

CONCLUSION

This is the first study examining the impact of reduction of basal insulin on hypoglycemia in adolescents. Reducing basal insulin during Ramadan fasting does not decrease the risk of symptomatic hypoglycemia. Use of the insulin pump does not appear to be different from MDI in the frequency of occurrence of hypoglycemia.

Authors+Show Affiliations

1 Paediatric Endocrinology Department, Mafraq Hospital , Abu Dhabi, United Arab Emirates .1 Paediatric Endocrinology Department, Mafraq Hospital , Abu Dhabi, United Arab Emirates .1 Paediatric Endocrinology Department, Mafraq Hospital , Abu Dhabi, United Arab Emirates .1 Paediatric Endocrinology Department, Mafraq Hospital , Abu Dhabi, United Arab Emirates .2 Institute of Public Health, Emirates University , Al Ain, United Arab Emirates .

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27500913

Citation

Deeb, Asma, et al. "Does Reducing Basal Insulin During Ramadan Fasting By Children and Adolescents With Type 1 Diabetes Decrease the Risk of Symptomatic Hypoglycemia?" Diabetes Technology & Therapeutics, vol. 18, no. 9, 2016, pp. 539-42.
Deeb A, Al Qahtani N, Attia S, et al. Does Reducing Basal Insulin During Ramadan Fasting by Children and Adolescents with Type 1 Diabetes Decrease the Risk of Symptomatic Hypoglycemia? Diabetes Technol Ther. 2016;18(9):539-42.
Deeb, A., Al Qahtani, N., Attia, S., Al Suwaidi, H., & Nagelkerke, N. (2016). Does Reducing Basal Insulin During Ramadan Fasting by Children and Adolescents with Type 1 Diabetes Decrease the Risk of Symptomatic Hypoglycemia? Diabetes Technology & Therapeutics, 18(9), 539-42. https://doi.org/10.1089/dia.2016.0197
Deeb A, et al. Does Reducing Basal Insulin During Ramadan Fasting By Children and Adolescents With Type 1 Diabetes Decrease the Risk of Symptomatic Hypoglycemia. Diabetes Technol Ther. 2016;18(9):539-42. PubMed PMID: 27500913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Reducing Basal Insulin During Ramadan Fasting by Children and Adolescents with Type 1 Diabetes Decrease the Risk of Symptomatic Hypoglycemia? AU - Deeb,Asma, AU - Al Qahtani,Nabras, AU - Attia,Salima, AU - Al Suwaidi,Hana, AU - Nagelkerke,Nico, Y1 - 2016/08/08/ PY - 2016/8/9/entrez PY - 2016/8/9/pubmed PY - 2017/11/4/medline SP - 539 EP - 42 JF - Diabetes technology & therapeutics JO - Diabetes Technol Ther VL - 18 IS - 9 N2 - BACKGROUND: Ramadan fasting by patients with type 1 diabetes might predispose them to hypoglycemia. There are no data on the optimal way of adjusting basal insulin during fasting. We aim at studying whether reducing basal insulin during Ramadan reduces the frequency of symptomatic hypoglycemia. METHODS: We enrolled children and adolescents with type 1 diabetes who intended to fast during Ramadan. Logbooks were given to subjects to mark days fasted, symptomatic hypoglycemia, and dose of basal insulin on all days of Ramadan. Logbooks were examined. Glucometers and insulin pumps were downloaded. RESULTS: Seventy-five patients were enrolled. The age was 10.2-18.9 (14.5) years. Sixty-eight patients had results analyzed. Forty-one patients were on pumps, and 27 patients were on multiple daily injections (MDI). Mean HbA1c was 7.9 (1.2) and 8.4 (1.3) for the pump and the MDI, respectively (P = 0.007). Thirty-nine patients had hypoglycemia leading to breaking fast. The mean number of episodes of breaking fast was 3 (1-8). Thirty-five of the 68 patients had reduced basal insulin. The difference in the frequency of hypoglycemia in those who reduced/did not reduce insulin was not statistically significant (P > 0.10). Fifteen patients on MDI and 24 patients on pumps had at least one episode of breaking fast. Six and 18 of the patients on MDI and pumps, respectively, reduced basal insulin (P > 0.10). CONCLUSION: This is the first study examining the impact of reduction of basal insulin on hypoglycemia in adolescents. Reducing basal insulin during Ramadan fasting does not decrease the risk of symptomatic hypoglycemia. Use of the insulin pump does not appear to be different from MDI in the frequency of occurrence of hypoglycemia. SN - 1557-8593 UR - https://www.unboundmedicine.com/medline/citation/27500913/Does_Reducing_Basal_Insulin_During_Ramadan_Fasting_by_Children_and_Adolescents_with_Type_1_Diabetes_Decrease_the_Risk_of_Symptomatic_Hypoglycemia L2 - https://www.liebertpub.com/doi/10.1089/dia.2016.0197?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -