• Patients with brittle diabetes (with poor control, hypo unawareness, frequent hypo and high blood sugar, severe kidney and eye complications and those prone to frequent diabetic ketoacidosis are at a high risk of developing severe complications and are advised not to fast).
• Regular blood glucose checks, especially pre sehri, 3 hours after Sehri, pre Iftar and 3 hours after Iftar, it will help in adjusting their insulin dose if needed.
• Recommended regimen could be; long acting basal insulin like Ultralente, Glargine or Detemir (In place of Isophane), at Sehri or Iftar and giving short acting insulin analogue (Lispro or humalog) 20-30% of the usual morning dose at Sehri and usual full morning dose at Iftar, to avoid hypoglycaemia at mid day.
• Where possible, take rest during the day to help avoid low blood glucose levels.
• These patients should have a fast and easy access to their local specialist diabetic nurse and physicians and they should be aware of the situation before hand.
