الفهرس 
DIABETES MELLITUSOnly 14 pages are availabe for public view
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Abstract
Some children and adolescents with type 1 diabetes, despite their exemption, insist on fasting in Ramadan. Objective: The aim of this study was to evaluate the effect of fasting on the metabolic parameters(mean blood glucose, glycosylated hemoglobin, lipid profile and frequency of hypoglycemia and hyperglycemia) and the effect of fasting on body mass index and body weight in adolescents with type1 diabetes mellitus. Also to compare the effectiveness of different insulin protocols during Ramadan fasting in type 1 diabetes mellitus. Materials and methods: In this prospective study 60 patients were recruited 3 months before the start of Ramadan, according to the following criteria: diabetics aged >11 years who compliant with diet and medications and with no history of sever hypoglycemia and or DKA at least 3 months before Ramadan and those with no comorbid conditions. Outcome measures included assessment of weight, BMI, change in HbA1c and lipid profile pre and post Ramadan and frequency of hypoglycemic, hyperglycemic and DKA during fasting. Prior to inclusion, Ramadan focused patient education was done prior to Ramadan, patients were given intensive education on insulin adjustment, home glucose monitoring, diatary adjustments and activity changes during Ramadan.Patients group:Group1: 26diabetics were follow the insulin regimen during their fasting by using 70% of the pre-Ramadan dose, divided as follows:70% as insulin glargine given in the evening and 30% as regular insulin given in 2 doses(at Suhur and Iftar).Group2: 34 diabetics were follow the insulin regimen during their fasting by using 70% of pre-Ramadan dose divided as 70% insulin NPH and 30% regular insulin, both given in 2 doses(at Suhur and at Iftar). The fast should be broken immediately if blood glucose drops below 70mg/dl and if blood glucose rises above 300md/dl. Result: In group1 diabetics there was a significant DROP HbA1c, in total cholesterol, MRBS, and significan rise in HDL (p <.05) although there was no significant change in weight, BMI, triglyceride and LDL. In group2 diabetics there was no significant change in weight, BMI, MRBS, HbA1c, total cholesterol, LDL and HDL while there was significant DROP in triglyceride (p<.05). Frequency of hypoglycemia and hyperglycemia was higher in group2 compared to group1 diabetics (p<0.04). Conclusion: It is feasible for adolescent with long-standing type 1 DM to safely fast during Ramadan, if the adolescent and family received proper education and intensive follow up clinic before and during Ramadan. Hypoglycemia was significantly reduced with insulin glargine compared with NPH human insulin. We recommended that patients wishing to fast be switched to long acting insulin.