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This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Major risks associated with fasting in patients with diabetes and their potential mechanisms (modified from references 11)*
Hypoglycaemia: Particularly increased in type 1 patients and in insulin-treated type 2 patients. This is due to restricted carbohydrate intake against ongoing action of previously admistered insulin/long acting oral hypoglycaemic agent.
Hyperglycaemia: Mainly in the evening time complicating gorging and in day day time complication overzealous reduction of the doses of insulin or oral hypoglycaemic agents.
Diabetic ketoacidosis or hyperglycaemic hyperosmolar states: due to absolute or relative insulin deficiency or due to associated intercurrent illness.
Dehydration and increased risk of thrombosis: particularly in the poorly controlled or the elderly and in environments of high temperatures particularly when fasting period is long.
Risk to the foetus: complicating any of the above.
These form the basis for advice against fasting in different clinical scenarios discussed in Table 3