Management of Diabetes Mellitus on Yom Kippur and Other Jewish Fast Days

Abstract

To create guidelines for patients with diabetes to fast safely on Yom Kippur and other Jewish fast days, with the primary goal of avoiding hypoglycemia. Almost 30 years of experience in endocrinology and the pharmacokinetics and pharmacodynamics of current drug therapy were applied to develop these guidelines and recommendations. A few illustrative cases are presented. Patients with either type 1 or type 2 diabetes were able to fast safely when a treatment plan was proactively formulated before the fast day. An understanding of which medications lower basal and which lower prandial blood glucose levels, as well as their duration of action, is critical. The overwhelming majority of patients with type 1 or type 2 diabetes can, from the perspective of blood glucose control, safely fast on Yom Kippur. Physician-patient discussion is important to prevent the patient from relying only on personal judgment and potentially taking too much medication, with the resultant development of hypoglycemia.