Terapi DM di Bulan Ramadhan

Iswandi Darwis

Bagian Ilmu Penyakit Dalam

Fakultas Kedokteran Universitas Lampung
Rumah Sakit Umum Daerah Dr. Hi. Abdul Moeloek
Bandar Lampung
 Curiculum vitae
• Nama : dr. Iswandi Darwis, M.Sc, Sp.PD
• Tempat Tanggal Lahir : Tangerang, 16 Juni 1986
• Alamat : Perum Palem Permai 2 Blok A3 Rajabasa Bandar
Lampung
• Telpon : 081287635855
• Email : iswandi.darwis@gmail.com
• Riwayat Pendidikan
– SD : SDN Tanah Tinggi 8 (1992-1998)
– SMP : SMPN 7 Tangerang (1998-2001)
– SMA : SMAN 2 Tangerang (2001-2004)
– S1 : Pendidikan Dokter FK Unila (2004-2010)
– Sp1 : Ilmu Penyakit Dalam FK UGM (2013-2017)
– S2 : Ilmu Kedokteran Klinik FK UGM (2014-2018)
• Pekerjaan : ASN Kementrian Riset Teknologi dan Pendidikan Tinggi (Dosen
Fakultas Kedokteran Universitas Lampung/SMF Ilmu Penyakit Dalam RSUD Dr.
H Abdul Moeloek Provinsi Lampung)
 Introduction
 Decreased food intake, well-known risk factor
hypoglycemia1
 The majority of muslims fast from dawn until dusk during
the annual islamic holy month of ramadan2
 Treatment guidelines recommend that most patients with
T2DM refrain from fasting during ramadan1,2
 Fasting increases the risk of hypoglycemia in patients
with T2DM who certain oral or injectable diabetes
medications2,4
 In a population-based study, the incidence of severe
hypoglycemic Events 7.5-fold during ramadan2,3

ADA=American Diabetes Association; T2DM=type 2 diabetes mellitus.

aThis report represents the collective analysis, evaluation, and opinion of the authors at the time of publication and does not represent the official position of the ADA.

1. Al-Arouj M et al. Diabetes Care. 2010;33(8):1895–1902.

2. Aravind SR et al. Curr Med Res Opin. 2011;27(6):1237–1242.
3. Salti I et al. Diabetes Care. 2004;27(10):2306–2311.
Changes in sleeping and meals pattern
Physiological response changes
 General consideration to be concern

• Individualized approach
• Glycaemic control
• Nutrition
• Physical activity
• Breaking the fast
 Individual approach and Glycaemic
control
• Individualized therapy in DM patients
management  comorbidity, BMI, age, its
complication
• Self monitoring blood glucose important for
know glycaemic control especially for DM
patients who use insulin
 Management fasting algorithm
2 month before fasting
Pre-fasting medical assessment Fasting education
•Individualize approach •Food planning
•Checking Blood Glucose, blood pressure, lipid profile, and renal function •Suitable activity
•Body mass index •Blood glucose monitoring
•Choice therapy and adjusted dose •Recognition and control of acute complication

Choose therapy
DPP-4 inhibitor / Oral
Metformin SU TZD Insulin
GLP1-AR insulinsecretagogue
Al-Arouj et al. Diabetes Care. 2010. 33; 189-1902
 Summary
• Type 1 DM patients have high risk
complication and life threatening than type 2
DM.
• Assessment 2 month pre-fasting neccessary
for clasify the risk
• Education is recommended, can decrease
occurance of hypoglycaemia
• Individualize therapy very important to start
treatment and adjusted while fasting
Happy Holy Ramadhan