| Abstract: |
The holy month of Ramadan is one of five main pillars of being a Muslim. Most Muslims are passionate about fasting during this month. However, Quran exempts sick people from the duty of fasting. Ramadan produces a beneficial metabolic profile in non-diabetic individuals. In a study of 24 healthy subjects during Ramadan, plasma total cholesterol (TC), triglycerides (TG), low-density- lipoprotein cholesterol (LDL-C), and very-low-density-lipoprotein cholesterol (VLDL-C) did not change, but high-density lipoprotein cholesterol (HDL-C) increased by 30% as did Apo lipoprotein A-I ,and the ratios of TC to HDL-C and LDL-C to HDL-C) decreased.( Maislos et al,1993) The metabolic benefits of fasting in diabetic patients are not so clear and, because of the increased theoretical risk of acute metabolic complications, fasting has not been previously encouraged. So it is important to review the literature and weigh up the potential benefits against any harm in fasting diabetic patients before recommendations can be issued. (Maislos et al, 1998) In 57 patients with type 2 diabetes from Iran, fasting during Ramadan resulted in an increase in TC and LDL with no effect on blood pressure, fasting blood glucose and serum fructosamine. (Yarahmadi et al, 2002) In the largest population-based retrospective survey to date 243 (8.7% type 1 diabetes, 91.3% type 2 diabetes) patients were studied. The incidence of severe hypoglycaemia was significantly increased during Ramadan compared with other months. In type 1 diabetes there was a 4.7-fold increase (0.14 vs. 0.03 episode/month) and in type 2 diabetes whilst the overall incidence of hypoglycaemia was less it was still increased 7.5-fold (0.03 vs. 0.004 episode/month). Severe hypoglycaemia appeared to be more frequent in subjects who changed their dose of oral agents and insulin or modified their level. (Salti et al, 2001) Ramadan fasting may be associated with hyperglycaemia and dehydration. Thus ketoacidosis has been reported especially with decrease fluid intake or omission of medications. (Abusrewil et al, 2003) Fasting proinsulin concentration is emerging as a possible surrogate indicator of β-cell dysfunction. (Alarcon et al, 1994) Studies have shown that proinsulin and the proinsulin-to-insulin ratio (PI/I) correlate significantly with acute insulin response from the frequently sampled IV glucose tolerance test. (Mykkanen et al, 1995)
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