Scribd
Upload
43 views3 pages

Fasting Risk Assessment

This document provides a 14-point risk assessment for fasting during Ramadan for individuals with diabetes. It assigns risk scores between 0 and 6.5 for factors like diabetes type and duration, history of hypoglycemia, kidney function, pregnancy status, and frailty. A total risk score of 0-3 indicates low risk and fasting is recommended, 3.5-6 indicates moderate risk and fasting is not advised, and over 6 indicates high risk and fasting should be avoided. It also provides dietary, exercise, medication adjustment, and blood glucose monitoring guidelines for fasting safely during Ramadan based on risk level.

Uploaded by

samleverk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
43 views3 pages

Fasting Risk Assessment

This document provides a 14-point risk assessment for fasting during Ramadan for individuals with diabetes. It assigns risk scores between 0 and 6.5 for factors like diabetes type and duration, history of hypoglycemia, kidney function, pregnancy status, and frailty. A total risk score of 0-3 indicates low risk and fasting is recommended, 3.5-6 indicates moderate risk and fasting is not advised, and over 6 indicates high risk and fasting should be avoided. It also provides dietary, exercise, medication adjustment, and blood glucose monitoring guidelines for fasting safely during Ramadan based on risk level.

Uploaded by

samleverk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

Fasting Risk Assessment:

1. Diabetes type and duration


Type 1 diabetes – 1
Type 2 diabetes – 0

2. Duration of Diabetes (years)


A duration of ≥ 10 – 1
A duration of < 10 – 0

3. Presence of hypoglycemia
Hypoglycemia unawareness – 6.5
Recent severe hypoglycemia – 5.5
Multiple weekly Hypoglycemia – 3.5
Hypoglycemia less than 1 time per week – 1
No hypoglycemia – 0

4. Level of glycemic control


HbA1c levels > 9% (11.7 mmol/L) – 2
HbA1c levels 7.5–9% (9.4–11.7 mmol/L) – 1
HbA1c levels < 7.5% (9.4 mmol/L) – 0

5. Type of treatment
Multiple daily mixed insulin Injections – 3
Basal Bolus/Insulin pump – 2.5
Once daily Mixed insulin – 2
Basal Insulin – 1.5
Glibenclamide – 1
Gliclazide/MR or Glimepride or Repeglanide – 0.5
Other therapy not including SU or Insulin – 0

6. Self-Monitoring of Blood Glucose (SMBG)


Indicated but not conducted – 2
Indicated but conducted sub-optimally – 1
Conducted as indicated – 0

7. Acute complications
DKA/ HONC in the last 3 months – 3
DKA/ HONC in the last 6 months – 2
DKA/ HONC in the last 12 months – 1
No DKA or HONC – 0

8. MVD Complications/Comorbidities
Unstable MVD – 6.5
Stable MVD – 2
No MVD – 0

9. Renal Complications/Comorbidities
eGFR < 30 mL/min – 6.5
eGFR 30–45 mL/min – 4
eGFR 45–60 mL/min – 2
eGFR >60 mL/min – 0

10. Pregnancy*
Pregnant not within targets* – 6.5
Pregnant within targets* – 3.5
Not pregnant – 0

11. Frailty and Cognitive function


Impaired cognitive function or Frail – 6.5
> 70 years old with no home support – 3.5
No frailty or loss in cognitive function – 0

12. Physical Labour


Highly Intense physical labour – 4
Moderate Intense Physical Labour – 2
No physical labour – 0

13. Previous Ramadan Experience


Overall negative experience – 1
No negative or positive experience – 0

14. Fasting hours (location)


≥ 16 hours – 1
< 16 hours – 0

Risk Score, IDF – DAR medical and religious recommendation:

0 – 3: Low: able to fast - Fasting is probably safe - Fasting is obligatory


3.5 – 6: Moderate: advised not to fast - Fasting safety is uncertain - Fasting is
preferred but patients may choose not to fast
> 6: High: should not fast - Fasting is probably unsafe - Advise against fasting

Medications adjustment:
- As follows:

Self-Monitoring of Blood Glucose (SMBG) - 7 point guide for Ramadan


- For those at moderate or low risk, this may be once or twice a day.
- Those at high or very high risk should check their blood glucose levels several times a day
- Timing of measurement:
1. Pre-dawn meal (suhoor)
2. Morning
3. Midday
4. Mid-afternoon
5. Pre-sunset meal (iftar)
6. 2 hours after iftar
7. At any time when there are symptoms of hypoglycemia/ hyperglycemia or feelings
of being unwell

Dietary advice
- Divide the daily calories between Suhoor and Iftar, plus one to two snacks if necessary.
- Ensure meals are well balanced
• 45% - 50% complex carbohydrates
E.g., barley, wheat, oats, millet, semolina, beans, lentils
• 20% - 30% protein
• <35% fat (preferably mono- and polyunsaturated)
- Include plenty of fruit, vegetables and salads
- Avoid sugary desserts
- Include low glycemic index, high-fibre foods that release energy slowly before and after
fasting
• E.g., granary bread, beans, rice
- Minimise foods that are high in saturated fats
• E.g. ghee, samosas, pakoras
- Use small amounts of oil when cooking
• E.g., olive, canola oil, rapeseed
- Keep hydrated between sunset and sunrise by drinking water or other non-sweetened
beverages
- Avoid caffeinated and sweetened drinks

Exercise
- Rigorous exercise should be avoided, particularly during the last hours of fasting (before
sunset) because it may lead to an increased risk of hypoglycemia and/or dehydration.

When to break the fast


- All individuals should break their fast if:
• Blood glucose <70 mg/dL
• Re-check within 1 hour if blood glucose is between 70–90 mg/dL
• Blood glucose >300 mg/dL
• Symptoms of hypoglycemia, hyperglycemia, dehydration or acute illness occur

You might also like