title: Safety and tolerability of once or twice daily neutral protamine hagedorn insulin in fasting pregnant women with diabetes during Ramadan.
abstract: OBJECTIVE
  To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan.
  
  
  METHODS
  This was a prospective cohort study conducted during Ramadan 2006 and 2007. Twenty four pregnant diabetic women were given NPH insulin once at 5 pm or twice daily at 5 pm and 5 am. Demographic data, blood glucose control, insulin requirement, days of fasting and hypoglycemic episodes were analyzed.
  
  
  RESULTS
  Most women were parity 1 (37.5%) in their second trimester (54.2%) and worked during the daytime (87.5%). Fourteen women (58.3%) had gestational diabetes mellitus, nine women (37.5%) had type 2 and one (4.2%) had type 1 diabetes mellitus. There were significant reductions in mean fasting blood glucose (6.16 mmol/L versus 5.34 mmol/L, P = 0.001), glycosylated hemoglobin (HbA1c) (6.70% ± 0.91 versus 6.64% ± 0.96, P = 0.001) and serum fructosamine (232.4 mmol/L ± 24.0 versus 217.0 mmol/L ± 24.3, P = 0.001) after Ramadan compared to before Ramadan. Throughout the four weeks of Ramadan, home blood glucose monitoring showed a reducing trend and was within the acceptable limits. Insulin requirement was increased from the first to the fourth week with a reduction in insulin dose noted after (38.5 U/day) compared to before the start of Ramadan (40 U/day). Most women (79.2%) were able to fast for more than 15 days without any hypoglycemia or fetal demise.
  
  
  CONCLUSIONS
  Once or twice daily NPH insulin is a safe and tolerable option for pregnant diabetics who wish to fast during Ramadan.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. azlinm@ppukm.ukm.my
authors.forename: Mohamed I
authors.initials: MI
authors.lastname: Nor Azlin
authors.forename: Rohaida
authors.initials: R
authors.lastname: Adam
authors.forename: Seri S
authors.initials: SS
authors.lastname: Sufian
authors.forename: Norashikin A
authors.initials: NA
authors.lastname: Wahab
authors.forename: Norlaila
authors.initials: N
authors.lastname: Mustafa
authors.forename: Nor A
authors.initials: NA
authors.lastname: Kamaruddin
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Jamil
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D016640:Diabetes, Gestational / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005215:Fasting; D005260:Female; D006801:Humans; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000627:therapeutic use*; D007514:Islam; D010298:Parity; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007336:Insulin, Isophane