During the month of Ramadan, Muslims fast, refraining from food and drink from dawn until dusk. Therefore, it is necessary to adjust the timing or dosage of blood sugar-lowering medications, especially for diabetes patients, as each medication relates to meals and blood sugar levels.
Principles for adjusting medication during fasting
Doctors will assess readiness, meal size, daily activities, and the risk of complications before advising on medication adjustments to control sugar and prevent hypoglycemia.
Examples of medications that rarely cause low blood sugar and can be used at a normal dosage
- Biguanides: Metformin (Glucophage®, Metformin®)
- Alpha-glucosidase inhibitors: Acarbose (Glucobay®)
- Thiazolidinediones: Pioglitazone (Actos®, Utmos®)
- DPP-4 inhibitors: Sitagliptin (Januvia®), Vildagliptin (Galvus®), Linagliptin (Trajenta®), Saxagliptin (Onglyza®), Alogliptin (Nesina®), Gemigliptin (Zemiglo®), Trelagliptin (Zafatek®)
- SGLT2 inhibitors: Dapagliflozin (Forxiga®), Canagliflozin (Invokana®), Empagliflozin (Jardiance®) – Be cautious of dehydration and ketoacidosis
- GLP-1 analogs: Liraglutide (Victoza®, Saxenda®), Dulaglutide (Trulicity®), Semaglutide (Ozempic®) – May cause nausea, consult a doctor if side effects occur
Medications that stimulate insulin secretion may cause low blood sugar; doctors may adjust the dosage or frequency appropriately to prevent hypoglycemia, such as
- Sulfonylureas: Glimepiride (Amaryl®), Gliclazide (Diamicron MR®), Glipizide (Minidiab®, Dipazide®), Glibenclamide (Daonil®, Sugril®)
- Non-sulfonylureas: Repaglinide (Novonorm®)
- Insulin: Humulin-R®, Humalog®, Novorapid®, Novomix 30®, Lantus®, Toujeo®, Levemir®, Tresiba®, Ryzodeg®, Soliqua®, Xultophy®
If hypoglycemia occurs (Glucose < 70 mg/dL)
Stop fasting, consume sugary drinks or foods (such as fruit juice, sweetened drinks). If symptoms do not improve, see a doctor immediately.
References
- Faris M. & Alliance International & Hassanein M. (2021). Diabetes and Ramadan: Practical Guidelines 2021.
- Guidelines for Diabetes 2017
- Al-Arouj M. et al. Recommendations for Management of Diabetes During Ramadan. Diabetes Care 33(8): 1895–1902.
Pharmacist Vorapoj Boonmathong
Bangkok Chiang Mai Hospital
