Fasting in people with diabetes can disrupt glucose homeostasis, and drug regimens often require modification to prevent complications such as hypoglycaemia and hyperglycaemia.
Ali is a 57-year-old man who has had type 2 diabetes for the past 20 years. He has taken a premixed insulin (aspart 30% and aspart protamine 70%) 20 units at breakfast and 20 units at dinner for the past five years. He also takes a slow-release preparation of metformin 2 g daily and gliclazide 60 mg daily. He is a regular patient at your clinic and today he visits you for follow up about his blood glucose control. His last HbA1c measurement six months ago was 5.4% (36 mmol/mol). During the consultation, you notice Ali is sweating profusely with shaky hands. His pulse rate is 112 beats per minute. He admits that he is fasting for Ramadan and had his last meal at 4 am that morning before sunrise; it is now 5 pm. He took his usual dose of insulin 20 units at the sunset meal (iftar) and 20 units at the sunrise meal (suhoor).
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