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Adjusting the basal insulin regimen of patients with type 1 diabetes mellitus receiving insulin pump therapy during the Ramadan fast: A case series in adolescents and adults

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dc.contributor.author Hawli Y.M.A.
dc.contributor.author Zantout M.S.
dc.contributor.author Azar S.T.
dc.contributor.editor
dc.date 2009
dc.date.accessioned 2017-10-05T15:41:01Z
dc.date.available 2017-10-05T15:41:01Z
dc.date.issued 2009
dc.identifier 10.1016/j.curtheres.2009.02.001
dc.identifier.isbn
dc.identifier.issn
dc.identifier.uri http://hdl.handle.net/10938/17777
dc.description.abstract Background: Ramadan, the ninth month of the Islamic lunar calendar, is the holy month of fasting for adolescent and adult Muslims. Observance of Ramadan is considered obligatory for every healthy adult Muslim. During this time, Muslims refrain from eating, drinking, smoking, and administering oral or parenteral medications from sunrise to sunset daily for 28 to 30 days. Case summary: We evaluated the need for changes in basal insulin regimen in 5 patients (4 males and 1 female; age range, 15-19 years) with type 1 diabetes mellitus (T1DM) who fasted during Ramadan. The patients were receiving insulin pump therapy with regular human insulin and maintained weekly visits with their endocrinologist at The Chronic Care Center (Beirut, Lebanon). They were instructed to break the fast after any episode of hypoglycemia (finger stick glucose 70 mg-dL) or severe hyperglycemia (finger stick glucose ≥300 mg-dL or any hyperglycemia associated with presence of urine ketone bodies on urinary dipstick). Blood glucose concentrations did not change significantly with fasting. Finger stick blood glucose taken at 4-hour intervals decreased in the afternoon (at 4 pm) and increased in the evening and morning (10 pm and 8 am, respectively) during this month in 4 of 5 patients, while no significant change in circadian rhythm of finger stick blood glucose was observed in 1 patient. Based on the investigators' findings, the basal insulin requirement decreased by 5.5percent to 25.0percent (4 patients) or did not change (1 patient) during the fast. Changes in regimens, based on collaboration between the endocrinologist and diabetes educational nurse, were determined by blood glucose self-monitoring done at 4-hour intervals during the fasting period, pre-Suhur (predawn breakfast), and ≥2 hours after Iftar (evening fast-breaking meal). No cases of keto-acidosis or severe hypoglycemia were reported. Conclusion: These 5 adolescent and adult patients with T1DM who were using an insulin pump were able to fast during Ramadan without incidences of severe hypoglycemia or ketoacidosis by using close blood glucose self-monitoring and weekly follow-up with their endocrine team, which consisted of an endocrinologist, a registered nutritionist, and a diabetes educational nurse. © 2009 Excerpta Medica Inc. All rights reserved.
dc.format.extent
dc.format.extent Pages: (29-34)
dc.language English
dc.publisher BRIDGEWATER
dc.relation.ispartof Publication Name: Current Therapeutic Research - Clinical and Experimental; Publication Year: 2009; Volume: 70; no. 1; Pages: (29-34);
dc.relation.ispartofseries
dc.relation.uri
dc.source Scopus
dc.subject.other
dc.title Adjusting the basal insulin regimen of patients with type 1 diabetes mellitus receiving insulin pump therapy during the Ramadan fast: A case series in adolescents and adults
dc.type Article
dc.contributor.affiliation Hawli, Y.M.A., Department of Internal Medicine, Division of Endocrinology, American University, New York, NY, United States, The Chronic Care Center, Beirut, Lebanon
dc.contributor.affiliation Zantout, M.S., Department of Internal Medicine, Division of Endocrinology, American University, New York, NY, United States
dc.contributor.affiliation Azar, S.T., Department of Internal Medicine, Division of Endocrinology, American University, New York, NY, United States, The Chronic Care Center, Beirut, Lebanon
dc.contributor.authorAddress Azar, S.T.; Department of Internal Medicine, Division of Endocrinology, American University, New York, NY, United States; email: sazar@aub.edu.lb
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine; Division: Endocrinology;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorDivision Endocrinology
dc.contributor.authorEmail sazar@aub.edu.lb
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Hawli, YMA
dc.contributor.authorInitials Zantout, MS
dc.contributor.authorInitials Azar, ST
dc.contributor.authorOrcidID
dc.contributor.authorReprintAddress Azar, ST (reprint author), Amer Univ Beirut, Med Ctr, Dept Internal Med, Div Endocrinol, 3 Dag Hammarskjod Plaza,8th Floor, New York, NY 10017 USA.
dc.contributor.authorResearcherID
dc.contributor.authorUniversity American University of Beirut Medical Center
dc.description.cited Al-Arouj M, 2005, DIABETES CARE, V28, P2305, DOI 10.2337-diacare.28.9.2305; Azar Sami T, 2008, J Med Liban, V56, P46; Azizi F, 1998, INT J RAMADAN FASTIN, V2, P8; Benaji B, 2006, DIABETES RES CLIN PR, V73, P117, DOI 10.1016-j.diabres.2005.10.028; Friedrich I., 2000, Harefuah, V138, P19; Kadiri A, 2001, DIABETES METAB, V27, P482; Kassem HS, 2005, J ENDOCRINOL INVEST, V28, P802; Pinar Rukiye, 2002, Br J Nurs, V11, P1300; RASHED AH, 1992, BRIT MED J, V304, P521; Salti I, 2004, DIABETES CARE, V27, P2306, DOI 10.2337-diacare.27.10.2306
dc.description.citedCount 1
dc.description.citedTotWOSCount 2
dc.description.citedWOSCount 2
dc.format.extentCount 6
dc.identifier.articleNo
dc.identifier.coden CTCEA
dc.identifier.pubmedID
dc.identifier.scopusID 62849105118
dc.identifier.url
dc.publisher.address 685 ROUTE 202-206, BRIDGEWATER, NJ 08807 USA
dc.relation.ispartofConference
dc.relation.ispartofConferenceCode
dc.relation.ispartofConferenceDate
dc.relation.ispartofConferenceHosting
dc.relation.ispartofConferenceLoc
dc.relation.ispartofConferenceSponsor
dc.relation.ispartofConferenceTitle
dc.relation.ispartofFundingAgency
dc.relation.ispartOfISOAbbr Curr. Ther. Res.-Clin. Exp.
dc.relation.ispartOfIssue 1
dc.relation.ispartOfPart
dc.relation.ispartofPubTitle Current Therapeutic Research - Clinical and Experimental
dc.relation.ispartofPubTitleAbbr Curr. Ther. Res. Clin. Exp.
dc.relation.ispartOfSpecialIssue
dc.relation.ispartOfSuppl
dc.relation.ispartOfVolume 70
dc.source.ID WOS:000264511600004
dc.type.publication Journal
dc.subject.otherAuthKeyword blood glucose concentration
dc.subject.otherAuthKeyword diabetes control
dc.subject.otherAuthKeyword insulin pump therapy
dc.subject.otherAuthKeyword Ramadan fasting
dc.subject.otherAuthKeyword type 1 diabetes
dc.subject.otherChemCAS human insulin, 11061-68-0
dc.subject.otherIndex human insulin
dc.subject.otherIndex ketone body
dc.subject.otherIndex adolescent
dc.subject.otherIndex adult
dc.subject.otherIndex article
dc.subject.otherIndex circadian rhythm
dc.subject.otherIndex clinical article
dc.subject.otherIndex diabetes control
dc.subject.otherIndex diet restriction
dc.subject.otherIndex drinking
dc.subject.otherIndex eating
dc.subject.otherIndex female
dc.subject.otherIndex follow up
dc.subject.otherIndex glucose blood level
dc.subject.otherIndex human
dc.subject.otherIndex hyperglycemia
dc.subject.otherIndex hypoglycemia
dc.subject.otherIndex insulin dependent diabetes mellitus
dc.subject.otherIndex insulin pump
dc.subject.otherIndex ketoacidosis
dc.subject.otherIndex ketonuria
dc.subject.otherIndex male
dc.subject.otherIndex meal
dc.subject.otherIndex moslem
dc.subject.otherIndex outcome assessment
dc.subject.otherIndex priority journal
dc.subject.otherIndex religion
dc.subject.otherIndex self monitoring
dc.subject.otherKeywordPlus
dc.subject.otherWOS Medicine, Research and Experimental
dc.subject.otherWOS Pharmacology and Pharmacy


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