Table 6.

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.
Patients on oral metformin	Consider adjusting timing of dose (ie, metformin 500 mg tid; during Ramadan change to metformin 1000 mg at sunset meal and 500 mg at predawn meal).
Patients on sulfonylureas	If once per day, adjust dose based on risk of hypoglycemia and give at sunset meal. If twice per day, use half the usual morning dose at the predawn meal and usual dose at the sunset meal.
Patients on premixed or intermediate acting insulin twice daily	Take usual dose at sunset meal and half usual dose at predawn meal. Also consider changing to long-acting in the evening and short-acting with meals.
Patients on long-acting insulin in the evening and short-acting with meals	Consider adjusting if at high risk of hypoglycemia or hyperglycemia, or continue with careful monitoring of blood glucose and adjust as necessary.

Adapted from Al-Arouj M, Assaad-Khalil S, Buse J, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care 2010;33:1901.