The objective of this article is to review important changes which may occur during Islamic FASTING in diabetic patients and the safety of FASTING during the Islamic month of RAMADAN for diabetics. Despite diverse findings regarding the physiological impact of RAMADAN on diabetics, researchers have not yet found, in the diabetics who fast, any pathological changes in body weight, blood glucose, HbA1c, C-peptide, insulin, fructosamine, cholesterol, or triglycerides. In the guidelines section of the article, we recommend that diabetic patients continue their regular daily activity and diet regimen. It is also critical that diabetics adjust their drug regimen, particularly those diagnosed as type 1 DIABETES MELLITUS. These three important factors, i.e. drug regimen adjustment, diet control, and daily activity constitute the “RAMADAN 3D Triangle”. With 3D attention, proper education, and DIABETES management, we conclude that most type 2 and some type 1 diabetic patients who insist on FASTING can carefully observe RAMADAN.

Background and Objective: In islam, there are several objectives for FASTING which include spiritual, psychological, social and physiological health promotion. However FASTING is prohibited for women with special physiological status, patients, children and elderly people. This study has reviewed the effects of FASTING on metabolic control of diabetic patients, published in literature.Materials and Methods: In this study pubmed, sciruse, findarticles, irandoc, Sir base & Google search engines have been searched for publication on the related subject. We used key words of RAMADAN, Moslem, metabolic control and DIABETES MELLITUS to search these database.Results: The outcome of our search showed great diversity among the results reported by different authors. Some reported that FASTING reduces some of the biochemical index and increased HDL cholestol. Other surveys concluded that FASTING causes hypoglycaemia. Based on the results of many studies, FASTING did not change FBS, Insulin, C-peptide, TG, HbA1c, fructosamine, but it could lead to Hypoglycemia and reduction of body weight.Conclusion: According to many studies, FASTING is prohibited for IDDM patients and it is needed for NIDDM patients to be evaluated before FASTING. Patients must be aware of the effect of diet, drugs regimen and physical activity. We also suggest both studies in national and international scales.

Although several studies have investigated the effects of RAMADAN FASTING on diabetic patients, the exact impacts on DIABETES control have not been well elucidated yet. There are neither precise quantitative criteria nor clear guidelines regarding RAMADAN FASTING for diabetic patients. This review aimed to discuss the results of previous studies. The neglected points in performed studies should be considered in the design and interpretation of future research related to RAMADAN FASTING in diabetic patients. A thorough research was carried out on the internet, using the following keywords: “RAMADAN”, “RAMADAN FASTING”, “Islamic FASTING”, “FASTING in RAMADAN”, and “FASTING”, in combination with words such as “DIABETES MELLITUS”, “hyperglycemia”, “hypoglycemia”, and “diabetic ketoacidosis”. Databases including PubMed, Google Scholar, and some regional databases were searched in order to find related articles (cross-sectional, descriptiveanalytical, cohort, clinical trial, and review studies), published during 1957-2013. The obtained data showed that RAMADAN FASTING could be non-risky for partially controlled diabetic patients. However, the safety of RAMADAN FASTING for diabetic patients with different blood glucose levels and complications is not yet determined. Many deficiencies and limitations are observed in the related studies such as the heterogeneity of participants including differences in lifestyle and circadian rhythm changes. Therefore, well controlled studies need to be performed to evaluate factors affecting blood glucose level during RAMADAN FASTING.

It is estimated that there are 1.1–1.5 billion Muslims worldwide, and prevalence of DIABETES is approximately 4.6%. Many patients with DIABETES insist on FASTING during RAMADAN, thereby creates a medical challenge for themselves and their physicians. These patients are susceptible to diabetic complications such as hypoglycemia and hyperglycemia. It is therefore important that medical professionals be aware of potential risks that may be associated with FASTING during RAMADAN. Patients who insist on RAMADAN FASTING be assessed before RAMADAN and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. In this article, management of DIABETES in RAMADAN is discussed.

Objective (s): The effect of RAMADAN FASTING on DIABETES control is not clear yet. Some lifestyle changes like changes in drug dose and time, sleep wake cycle, physical activity and diet occur in RAMADAN and can lead to metabolic imbalances. As such some studies have shown increased risk of hyperglycemia and hypoglycemia. So, it is necessary to make decision based on scientific evidences about safety and allowing FASTING in a wide variety of patients on different stages of metabolic control. Moreover, appropriate changes in drug prescription should be recognized and used. In this review the results of various studies regarding the effects of RAMADAN FASTING on metabolic control of type 1 and 2 DIABETES MELLITUS have been summarized and provided.Method: Keywords including "RAMADAN", "RAMADAN FASTING", "Islamic FASTING", FASTING in RAMADAN ", Calorie Restriction, FASTING and Starvation with words DIABETES MELLITUS, Hyperglycemia, Hypoglycemia, Ketoacidosis, Glucose were searched via PubMed, SID (Scientific Information Database), and some regional journals and all articles (descriptive cross - sectional, cohort, clinical trial and review articles) from 1957 to 2010. The relevant articles were reviewed.Results: In all 86 papers were included in this review. In diabetic patients safety of RAMADAN FASTING is defined as blood glucose in normal range. In type 2 diabetics with no chronic complication and able to self care, with proper training, planning the time and dose of drug, controlling of diet and physical activity and regular monitoring of blood glucose, FASTING is allowed. In type 1 diabetics or insulin users, FASTING should be allowed with caution, because, they are more at risk of hypoglycemia.Conclusion: Diabetic patients who wish to fast in RAMADAN need to care about time, type and dose of their medications.

Background: Regarding to high prevalence of DIABETES MELLITUS among Iranian Muslims, and due to the importance of metabolic control in these patients and existence of some vague and contraversial information about the effect of FASTING in diabetic patients, this study was designed to detect the effect of RAMADAN FASTING on some metabolic indices in diabetic patients. Materials and methods: This is a quasi-experimental study. All of the patients with type 2 DIABETES who wished to keep FASTING in RAMADAN were selected 3 days before RAMADAN .All of the patients were on oral hypoglycemic agents. Their height, weight, body mass index, systolic and diastolic blood pressure, FASTING and 2 hour post prandial serum glucose, serum cholesterol, LDL and HDL cholesterol, triglyceride, insulin, creatinin and hemoglobin A1c were measured. At the end of RAMADAN the patients were visited again. All of the patients with less than 20 sequential days of FASTING were excluded from the study. Changes in the above markers were analysed by paired t-test and sign-test. Results: The survey was carried out on 40 patients (24 females and 16 males). A significant statistical reduction in weight, body mass index, serum cholesterol, creatinine and also in serum insulin was observed at the end of the study (P<0.05). There was a significant elevation in the level of FASTING blood sugar but, there was no change in the level of HbA1c and 2 hour post prandial blood sugar. Total cholestrol level was reduced after RAMADAN but, no significant changes was observed in the level of HDL, LDL cholestrol and triglyceride. The changes in systolic and diastolic blood pressure were not significant, either. There were no complications such as hypoglycemia in our patients during FASTING.Conclusion: RAMADAN FASTING not only is not harmful for type 2 DIABETES MELLITUS but also is useful for fat diabetic patients. Further studies with more patients specially patients taking insulin is recommended.

RAMADAN defines a month-long (29– 30 day) obligatory FASTING for all healthy Muslims. The length of FASTING is dependent on one’ s geographic location (at some parts of the world the FASTING duration can last for up to 18 hours). In this holy month followers must abstain from eating and drinking between dawn and sunset, and must also abstain from using oral medications and smoking. However, exemptions exist for subjects with medical conditions, including DIABETES and pregnancy (1)...

RAMADAN, the holy month of Muslims, is the ninth month of the Islamic calendar. During FASTING, plasma glucose levels and circulating insulin decrease gradually and counter regulatory hormones such as glucagon and catecholamines tend to rise.Diabetic Muslims who insist on FASTING should be aware of potential complications and techniques of decreasing the risks.Muslims should be evaluated 2-4 weeks before RAMADAN and high risk patients should not fast. Low risk patients should receive adequate education and appropriate medication change to cope with FASTING. During RAMADAN frequent blood glucose monitoring is an effective method for preventing hypoglycemia.Nutritional change is an essential component for safe FASTING. In this article we was review studies that evaluate changes that would affect diabetic patients in RAMADAN.