Insulin pump therapy in Moslem patients with type 1 diabetes during Ramadan fasting: an observational report.
BACKGROUND
Many Moslem patients do observe the fast during Ramadan. There are limited data on insulin pump therapy during Ramadan. We report our experience with type 1 diabetes patients on insulin pumps during Ramadan 2008 (29 days).


METHODS
A total of 63 patients were evaluated. Forty-nine patients fasted, and 14 elected not to fast. Those who fasted (24 males, 25 females) were 22 +/- 7 years of age (mean +/- SD) and had had diabetes for 9.6 +/- 5.6 years. Patients used the Medtronic (Northridge, CA) MiniMed 722 model and had been using pump therapy for 20 +/- 10 months. Outcome measures included number of days fasted, hypoglycemia, unusual hyperglycemia, and number of emergency hospital visits.


RESULTS
Thirty patients (61.2%) fasted the whole month with no problems, nine (18.4%) fasted 27-28 days, eight (16.3%) fasted 24-25 days, and two (4.1%) fasted 23 days. Nearly half of the patients decreased their basal insulin by 5-50% of their prefasting doses. Seventeen patients had hypoglycemia requiring breaking the fast. Fasting was broken on 55 out of 1,450 potential fasting days (3.8%). No severe hypoglycemia was reported by any patient. Unusual hyperglycemia was reported in nine patients (18.4%). Hospital visits were reported for one patient for hyperglycemia (a 16-year-old girl who disconnected her pump). Twelve patients had fructosamine levels measured both before and immediately after Ramadan; pre-Ramadan fructosamine level was 4.0 +/- 0.6 mmol/L, and the post-Ramadan value was 3.6 +/- 0.6 mmol/L (P = 0.007).


CONCLUSIONS
Fasting during Ramadan is feasible in patients with type 1 diabetes using an insulin pump, with adequate counseling and support.
Benbarka
Mahmoud M
MM
Center for Diabetes and Endocrinology , Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates. mbenbarka@skmc.gov.ae
Khalil
Ali B
AB
Beshyah
Salem A
SA
Marjei
Suhad
S
Awad
Samar Abu
SA
D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005215:Fasting / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006693:Holidays; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D007514:Islam; D008297:Male; D055815:Young Adult
D007004:Hypoglycemic Agents; D007328:Insulin