Table 2.

Insulin regimen adjustments in people with type 2 diabetes who are fasting for Ramadan

Regimen	Suggested adjustments
Single basal (or premixed) insulin	Take insulin before dinner (Iftar) Empirical reduction of dose by 30% (if blood glucose is well controlled pre-Ramadan) Adjust dose as per home blood glucose monitoring to avoid daytime (especially late in the day/pre-Iftar) hypoglycemia
Twice daily premixed (or basal) insulin	Take the usual larger dose at Iftar Reduce the smaller dose (usually before dinner) by 30% to coincide with pre-Suhur/early morning meal Adjust doses to avoid early morning and pre-sunset hypoglycemia
Twice daily premixed insulin plus bolus insulin before lunch	Take the usual larger dose at Iftar Omit the bolus dose unless the patient’s eating profile includes a large meal at midnight
Basal-bolus insulin	Basal insulin to be taken pre-Iftar without dose change Bolus dose taken before Iftar may need to be augmented Bolus dose taken before Suhur is either omitted or reduced to avoid daytime hypoglycemia
Premeal boluses	Adjust the pre-Iftar dose to avoid postprandial hyperglycemia Adjust the pre-Suhur dose to avoid daytime hypoglycemia