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fasting with diabetes mellitus
Indications:
- fasting for procedures
- regious reasons
Management:
1) overnight fasts
a) get fasting labs done prior to 9 AM
b) hold oral hypoglycemic agents & short-acting insulin until eating
c) not necessary to discontiune metformin, glitazones, incretin mimetics, or gliptins since these agents by themselves seldom cause hypglycemia
2) fasts longer than overnight
a) hold oral hypoglycemic agents the evening prior to & during the fast
b) hold short-acting insulin while fasting
c) consider reducing dose of long-acting insulin by 1/3 to 1/2
3) diabetes mellitus type 1
- do NOT stop basal insulin.
- some insulin is still needed during fasting to prevent diabetic ketoacidosis
4) diabetes mellitus type 2
- supervised fasting could eliminate the need for insulin in some patients with type 2 diabetes [2]
5) Ramadan
a) patients fast during the day & eat only at night
b) consider switching to QHS or once a day evening dosing of hypoglycemic agents during Ramadan
c) discourage fasting if
- pregnant
- acutely ill
- diabetes mellitus is poorly controlled
6) stop fast if blood glucose < 70 mg/dL
General
fasting
References
- Prescriber's Letter 18(7): 2011
COMMENTARY: Fasting in the Patient with Diabetes
PATIENT HANDOUT: Diabetes and Fasting
PATIENT HANDOUT SPANISH VERSION: Diabetes y Ayuno
Detail-Document#: 270703
(subscription needed) http://www.prescribersletter.com
- Furmli S, Elmasry R, Ramos M, Fung J
Therapeutic use of intermittent fasting for people with
type 2 diabetes as an alternative to insulin.
BMJ Case Reports 2018. Oct 9.
PMID: 30301822
http://casereports.bmj.com/content/2018/bcr-2017-221854