Table 3.

Recommended changes to treatment regimen in patients with type 2 diabetes who fast during Ramadan

Before Ramadan	During Ramadan
Patients on diet and exercise control	Consider modifying the time and intensity of physical activity; ensure adequate fluid intake
Patients on oral hypoglycemic agents	Ensure adequate fluid intake
Biguanide, metformin 500 mg, three times daily	Metformin, 1,000 mg at the sunset meal, 500 mg at the predawn meal
TZDs, AGIs, or incretin-based therapies	No change needed
Sulfonylureas once a day	Dose should be given before the sunset meal; adjust the dose based on the glycemic control and the risk of hypoglycemia
Sulfonylureas twice a day	Use half the usual morning dose at the predawn meal and the usual dose at sunset meal
Patients on insulin	Ensure adequate fluid intake
Premixed or intermediate-acting insulin twice daily	Consider changing to long-acting or intermediate insulin in the evening and short or rapid-acting insulin with meals; take usual dose at sunset meal and half usual dose at predawn meal

AGI, α-glucosidase inhibitor; TZD, thiazolidinedione. Note: The recommendations given in this table are for illustrative purposes and are largely based on expert clinical opinion and not on scientific data derived from clinical studies. The recommendations must be adjusted for each specific patient. Adapted from Akbani et al. (43).