Insulin degludec (IDeg) is an ultra-long-acting insulin, with flat time-action profile, having a lower risk of hypoglycemia.The study assessed frequency, timing and severity of hypoglycemia of insulin IDeg as basal insulin in T1DM adolescence who are willing to fast.
Thirty eight patients (19 males) with T1DM (mean age 15.8 ± 3.4 years) and duration of diabetes (5.2 ± 1.7 years) were included. Patients had their IDeg doses titrated using pre- Iftar (sunset-meal) and pre-Suhur (sunrise-meal) glucose values. Participants were able to adjust their bolus doses according insulin to carbohydrates ratios. IDeg was reduced initially by 15% of pre‑Ramadan dose and administered at time of Iftar. Patients were monitored using the FreeStyle Libre® flash glucose monitoring (FGM)system.
Mean BG was 176 ± 49 mg/dl and overall time spent in hypoglycemia was 5.7%±3.0% of total monitoring period. Rate of hypoglycemia according to time intervals was 0%,3%, 8%, 15%and 64% in (19:00–24:00), (24:00–04:00), (04:00-10:00), (10:00–14:00) and (14:00–19:00) respectively. Out of all hypoglycemic flashes for patients, 74% were between60 and 69 mg/dl, 23% between 50 and 59 mg/dl, and 5% below 50mg/dl. There was no significant change (p = 0.211) in glycemic control measured by fructosamine level between pre-Ramadan ( 221.7 ± 63.8 mg/dL) and end-of-Ramadan ( 234.8 ± 71.7 mg/dL).Basal insulin was reduced by 35±18%.
Hypoglycemia was encountered in the last few hours of fasting preceding Iftar time necessitating dose reduction to minimize the severity and duration of hypoglycemia. This helps adolescents with T1DM observe Ramadan in a healthy and fulfilling manner under close supervision.