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Diabetes and Ramadan - 2021 Practical Guidelines from International Diabetes Federation (IDF) and the Diabetes and Ramadan International Alliance (DAR)  https://www.daralliance.org/daralliance/idf-dar-practical-guidelines-2021/#:~:text=A%20cornerstone%20of%20managing%20diabetes,episodes%20of%20low%20blood%20glucose.

ADCES Fasting Tip Sheet: https://www.diabeteseducator.org/docs/default-source/practice/educator-tools/fasting_tip_sheet.pdf?sfvrsn=2

1. When is Ramadan: Saturday April 2- Sunday May 1
2. What is Ramadan: a holy month for Muslims during which time the consumption of food or drink is forbidden between dawn and dusk
   1. Iftar: sunset meal “breaking the fast” – usually bigger meal containing
   2. Suhoor – pre-dawn meal
   3. Ramadan Nutrition Plan (RNP)
      1. Aim for individuals to consume adequate calories with balanced proportions of macronutrients during non-fasting periods to prevent hypoglycemia during the fasting period
      2. PWD equally distribute Carbohydrate intake between meals to minimize post-prandial hyperglycemia
   4. Health concerns regarding fasting (1) hypoglycemia, late period of fasting, pre-iftar. (2) Severe hyperglycemia (3) dehydration (4) electrolyte imbalances (5) acute kidney injury – usually from dehydration (6) DKA
   5. When to break the fast
      1. BG <70 or sx of hypoglycemia
      2. Acute illness
      3. BG >300 in individuals who had previously well controlled BG
   6. DM and Medications
      1. OK to continue DPP4, GLP1, TZDs without adjustments
      2. SGLT2 are ok to continue, be thoughtful about vulnerable patients for risks of dehydration or DKA
      3. Metformin, SU, insulin, should be assessed and dose adjustment recommendations are below

Pharmacists and CDCES are uniquely positions to offer patients with T2DM counseling around safe fasting practices and how to manage or adjust medications during the fast as well as providing education around avoiding hypoglycemia with specific nutrition recommendations.