The Role of Diabetes Educators in Reduction the Risk of Hypoglycemia in Type 1 Patients during Fasting Ramadan

Abstract

Background/Objectives: Fasting Ramadan for type 1 patients could be a challenging for both patients and physicians due to complications such as hypoglycemia, so in this study we choice to introduce glucose sensor and intensify the role of diabetes educator follow-up for type 1 patients who already on pump and willing to fast Ramadan for the first time. Design and Methods: This is a pilot prospective cohort study. Total of 6 patients (4 females and 2 males) with type 1 diabetes were recruited. Their mean age is (21.8+/-2.2) years, diabetes duration(11.1+/-2.3) years, mean duration on insulin pump is (4+/-1.6)years. Insulin basal rates of infusion were reduced 5-10% during fasting hours and increased between 5-10% after breaking fast. Weekly follow-up visits during Ramadan took place as well a daily follow-up by phone with the educator. Patients were asked to wear glucose sensor for entire days of fasting to detect hypoglycemia. Results: An (28.8+/- 8.6) units for 24 hours of basal insulin were set before fasting, and (26.8+/- 7.5) units for 24 hours of basal insulin were required for fasting Ramadan, and from that (15.1+/-4.3) units was basal insulin for total hours of fasting(14 hours), part of it explained by food habitus and lack of activity during Ramadan. An average of blood glucose was (11.1+/-2.1) mmol/l an hour before futoor, (9.7+/-3.8) mmol/l two hours after futoor, and (12.5+/- 3.4) mmol/l at suhoor. On the first week, four hypoglycemic episodes (BG less than 3.9 mmol/l), daily follow-up by diabetes educator, pop up visit in educator office and weekly visit to physician and educator office reduce the episode of hypoglycemia by the 2nd week till the 4th week of Ramadan. Conclusions: The use of glucose sensor together with adjustment of basal insulin wasn’t enough to minimzing the fear of fasting Ramadan but with role of diabetes educator reduce the risk of further hypoglycemia episode. Disclosure S. Mourad: None.