Table of Contents
Section 1 Overview
1 Overview Sanjay Kalra 3
Health 3
Intrusion in Health 3
Ramadan 4
Biopsychosocial Model 4
Person Centered Care 4
The Role of the Physician 5
Newer Drugs and Technologies: The Knowledge Paradox 5
The Flow of this Book 6
2 Introduction Mahdi Kamoun Mouna Feki Mnif Jnes Slim 7
3 Pre-Ramadan Counseling Altamash Shaikh 12
Goals of Counseling 12
Prerequisites 13
Awareness Revolutions/Campaigns 13
Ramadan Education and Role of the Health Care Providers 13
Counseling Strategies 14
Counseling Content for the Patients 15
Benefits of Pre-Ramadan Counseling 20
Conflict of Interest 21
4 Endocrinology of Fasting Ines Slim Mahdi Kamoun Mouna Feki Mnif 22
Definition, History and Circumstances of Fasting 23
Metabolic and Hormonal Changes during Ramadan Fasting in Healthy Persons 24
Effect of Ramadan Fasting in Patients with Diabetes Mellitus 30
Effect of Ramadan Fasting on Cardiovascular Risk 34
Other Health Risks of Ramadan Fasting 35
5 Risk Stratification of People with Diabetes Altamash Shaikh 39
Why Stratify? 39
What are the Risks? 40
How to Stratify? 40
Whom to Stratify? 40
Special Situation 44
Benefits of Risk Stratification 44
6 Beneficial Effects of Ramadan Fasting on Health Mahdi Kamoun Mouna Feki Mnif Ines Slim 45
Beneficial Ramadan Fasting Effects on Diabetic Patients 46
Beneficial Ramadan Fasting Effects on Nondiabetic Patients 47
Section 2 Nonpharmacological Management
7 Monitoring Diabetes Patient during Ramadan Abdul Jabbar 61
Glycosylated Hemoglobin 64
Fructosamine 64
8 Nutrition Recommendations for Persons with Diabetes during Ramadan Sarita Bajaj 67
How the Fast is Observed 68
Diabetes and Fasting during Ramadan 68
The Physiological State of Diabetics During Ramadan 68
Effect of Fasting on Various Metabolic Parameters In Diabetics 69
Pre Ramadan Considerations in Diabetics 70
Complications that Might be Associated with Fasting in Diabetics 71
Risk Stratification of Patients with Diabetes during Ramadan 73
Management of Diabetics during Ramadan 73
9 Physical Activity in Ramadan Altamash Shaikh 79
Pathophysiology of Exercise in Diabetes and Ramadan 79
Exercise, Sportsmanship and Ramadan 80
Goals: Exercise and Ramadan 80
Pre-Exercise Evaluation and Ramadan 80
Exercise Type/Time in Diabetes and Ramadan 80
Exercise, Hypoglycemia and Ramadan 81
Exercise, Diet Controlled Diabetes and Ramadan 81
Exercise, Tarawih Prayer and Ramadan 81
Exercise, Hyperglycemia and Ramadan 81
Role of Physical Activity, Weight and Ramadan 82
Exercise, Physical Labor and Ramadan 82
Exercise, Dehydration and Ramadan 82
Benefits of Physical Activity and Ramadan 82
Recommendations for Physical Activity in Ramadan 82
10 Stress Management and Diabetes in Ramadan Altamash Shaikh 85
Why Manage Stress in Diabetes? 85
Mechanism 86
Psychosocial Advantages of Ramadan Fasting Pre-Ramadan Counseling and Stress 87
The Solution 87
Stress, Distress and Destress 89
Clinical Implications 89
Recommendations 90
Section 3 Pharmacological Management
11 Traditional Oral Antidiabetic Drugs in Ramadan Shariq Rashid Masoodi 95
Treatment Modalities during Ramadan 96
Diabetic Medication Adjustment during Ramadan 102
12 Incretin-based Therapies and Fasting during Ramadan Mahdi Kamoun Mounn Feki Mnif Ines Slim 105
Physiological Effects of the Incretin Hormones GLP-1 107
Dipeptidyl Peptidase-4 Inhibitors and Ramadan Fasting 108
GLP 1 Receptor Analogs and Ramadan Fasting 111
13 Type 1 Diabetes Mellitus and Fasting during Ramadan Rakesh Saltan V Sri Nagesh 116
Altered Pathophysiology during Fasting 117
Complications of Fasting 117
Pre-Ramadan Medical Assessment 119
Structured Diabetes Education 120
Management 120
Future Perspectives 123
14 Insulin in Type 2 Diabetes Mellitus Altamash Shaikh Manoj Chadha 126
Why Insulin in Ramadan? 126
Prerequisites for Insulin in Ramadan 127
Stratification before Ramadan Insulin Initiation 127
Insulin, Counseling and Ramadan 128
Insulin Individualization and Ramadan 128
Insulin Initiation (Insulin Naive Patients) and Ramadan 129
Insulin Continuation and Ramadan 129
Insulin Optimization and Ramadan 130
Insulin Intensification and Ramadan 132
Insulin and Oad (Oral Antidiabetic Drugs) in Ramadan 132
Insulin, Glucagon-Like Peptide-1 and Ramadan 132
Conventional Insulin Versus Analogs in Ramadan 134
Insulin, Pregnancy and Ramadan 134
Insulin, Elderlyand Ramadan 135
Insulin Pumps and Ramadan 135
Insulin, Weight and Ramadan 136
Insulin. Hyperglycemia and Ramadan 136
Insulin, Hypoglycemia and Ramadan 136
Breaking the Fast 136
Insulin, Family Therapy and Ramadan 137
Future Insulin and Ramadan 137
Insulin and Blood Glucose Monitoring during Ramadan 137
Section 4 Special Situation in Ramadan
15 Ramadan Fasting in Children and Adolescents Anish Ahamed 143
Pathophysiology of Fasting 144
Ramadan-Focused Patient Education 145
Pre-Ramadan Medical Assessment 146
Nutritional Advice 146
Physical Activity 146
Checking Glycemic Status 146
When Should you Advise the Child to Break the Fast? 146
Insulin in Type 1 Diabetes 147
Type 2 DM in Children and Adolescents 148
16 Ramadan Fasting in Women Sarita Eajaj 149
Pregnancy and Ramadan 150
Lactation and Ramadan 153
Sickness and Medication 153
17 Ramadan Fasting in Elderly Jamal Ahmad 156
Islamic Ruling on Fasting for Elderly 157
Management of Elderly with Diabetes Mellitus during Ramadan 157
Section 5 Management of Complications
18 Hypoglycemic Emergencies Intekhab Ahmed 165
Clinical Manifestations 166
Magnitude of the Problem 167
Risk Factors for Hypoglycemia 168
Strategies to Prevent Hypoglycemia 169
Treatment of Hypoglycemia 171
19 Hyperglycemic Emergencies in Ramadan Intekhab Ahmed 174
Pathogenesis 175
Clinical Presentation 178
Laboratory Findings 180
Differential Diagnosis 183
Treatment 183
Airway, Breathing and Circulation, IV Access and Monitoring 184
Preventive Measures 185
20 Dyselectrolytemia in Ramadan Bashir Ahmad Laway Nazir Ahmad Pala 188
Renal Response to Ramadan Fasting 189
Concluding Remarks 191
Recommendations 192
21 Management of Diabetic Patients with Co-morbid Conditions during Ramadan Mahdi Kamoitn Ines Slim Mouna Feki Mnif 195
General Considerations in Management of Diabetic Patients With Co-Morbid Conditions 196
Management of Diabetic Patients with Selected Comorbidities during Ramadan 199
Index 207
