Table 3

Recommended changes to treatment regimen in patients with type 2 diabetes who fast during Ramadan

Before RamadanDuring Ramadan
Patients on diet and exercise controlConsider modifying the time and intensity of physical activity; ensure adequate fluid intake
Patients on oral hypoglycemic agentsEnsure adequate fluid intake
Biguanide, metformin 500 mg, three times dailyMetformin, 1,000 mg at the sunset meal, 500 mg at the predawn meal
TZDs, AGIs, or incretin-based therapiesNo change needed
Sulfonylureas once a dayDose should be given before the sunset meal; adjust the dose based on the glycemic control and the risk of hypoglycemia
Sulfonylureas twice a dayUse half the usual morning dose at the predawn meal and the usual dose at sunset meal
Patients on insulinEnsure adequate fluid intake
Premixed or intermediate-acting insulin twice dailyConsider changing to long-acting or intermediate insulin in the evening and short or rapid-acting insulin with meals; take usual dose at sunset meal and half usual dose at predawn meal
  • AGI, α-glucosidase inhibitor; TZD, thiazolidinedione. Note: The recommendations given in this table are for illustrative purposes and are largely based on expert clinical opinion and not on scientific data derived from clinical studies. The recommendations must be adjusted for each specific patient. Adapted from Akbani et al. (43).