Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Diabetes Care 29:746 2006
DOI: 10.2337/diacare.29.03.06.dc05-2302
© 2006 by the American Diabetes Association
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by El-Kebbi, I. M.
Right arrow Articles by Ismail-Beigi, F.
Right arrow Search for Related Content
PubMed
Right arrow Articles by El-Kebbi, I. M.
Right arrow Articles by Ismail-Beigi, F.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Letters: Comments and Responses

Recommendations for Management of Diabetes During Ramadan

Response to Elhadd and Al-Amoudi and to Davidson

Imad M. El-Kebbi, MD1, Mahmoud Ashraf Ibrahim, MD2 and Faramarz Ismail-Beigi, MD, PHD3

1 Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
2 Egyptian Diabetes Center, Cairo, Egypt
3 Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio

Address correspondence to Mahmoud Ashraf Ibrahim, MD, Egyptian Diabetes Center, 19 Nasouh St., Zeitoun, Cairo, Egypt 11321. E-mail: mahmoud{at}arab-diabetes.com

We thank Elhadd and Al-Amoudi (1) for their comments and interest in our article (2). Like them, we are also concerned by the very high rate of severe hypoglycemia and hyperglycemia in patients with diabetes who fast during Ramadan. We agree with them that patients with renal disease may have increased risk of hypoglycemia and that adolescent patients with poor glycemic control or recurrent hypoglycemia may also represent high-risk patients for developing hypoglycemia during fasting.

We thank Davidson (3) for his remarks. Our intent in recommending the addition of complex carbohydrates to a mixed meal at predawn was to keep a sustained increase in the appearance of glucose in the circulation to avoid hypoglycemia. We agree that initiation of hydrolysis of carbohydrates and the rate of appearance and the level of glucose soon after ingestion of simple or complex carbohydrates are fairly similar (4,5). However, these studies suggest that following the ingestion of complex carbohydrates, the day-long glucose concentrations (4) and the area under the curve for glucose (5) are larger for complex carbohydrates. Similar to these findings, Wolsdorf et al. (6) found that ingested uncooked starch behaves as a reservoir for continuous release of glucose compared with the absorption of ingested dextrose that occurs over a shorter period of time. Finally, and most importantly, ingestion of simple carbohydrates in the absence of additional protein or fat at Ifatr (the breaking of the fast) enables rapid absorption of glucose when blood glucose levels are apt to be at their nadir, levels that could explain the relatively higher rates of hypoglycemia in the pre-Iftar period (7).

References

  1. Elhadd TA, Al-Amoudi AA: Recommendations for management of diabetes during Ramadan (Letter). Diabetes Care 29:744-745, 2006
  2. Al-Arouj M, Bougeurra R, Buse J, Hafez S, Hassanein M, Ibrahim MA, Ismail-Beigi F, El-Kebbi I, Khatib O, Kishawi S, Al-Madani A, Mishal AA, Al-Maskari M, Nakhi AB, Al-Rubean K: Recommendations for management of diabetes during Ramadan. Diabetes Care 28:2305–2311, 2005[Free Full Text]
  3. Davidson MB: Recommendations for management of diabetes during Ramadan (Letter). Diabetes Care 29:745, 2006[Free Full Text]
  4. Hollenbeck CB, Coulston AM, Donner CC, Williams RA, Reaven GM: The effects of variations in percent of naturally occurring complex and simple carbohydrates on plasma glucose and insulin response in individuals with non-insulin-dependent diabetes mellitus. Diabetes 34:151–155, 1985[Abstract]
  5. Wahlqvist ML, Wilmshurst EG, Richardson EN: The effect of chain length on glucose absorption and the related metabolic response. Am J Clin Nutr 31:1998–2001, 1978[Abstract/Free Full Text]
  6. Wolfsdorf JI, Plotkin RA, Laffel LM, Crigler JF Jr: Continuous glucose for treatment of patients with type 1 glycogen storage disease: comparison of the effects of dextrose and uncooked starch on biochemical variables. Am J Clin Nutr 52:1043–1050, 1990[Abstract/Free Full Text]
  7. Akram J, De Verga V, the Ramadan Study Group: Insulin lispro (Lys(B28), Pro(B29)) in the treatment of diabetes during the fasting month of Ramadan. Diabet Med 16:861–866, 1999[Medline]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by El-Kebbi, I. M.
Right arrow Articles by Ismail-Beigi, F.
Right arrow Search for Related Content
PubMed
Right arrow Articles by El-Kebbi, I. M.
Right arrow Articles by Ismail-Beigi, F.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum