Insulin dose redistribution and titration during Ramadan

What it is

Two tables carry insulin through the fasting month. Table 3.6 sets where the standing dose goes, at iftar and at suhoor, and by how much it is cut. Table 3.7 then adjusts it every three days against the BG level.

Basal insulin

• Long- or intermediate-acting basal insulin, NPH/Detemir/Glargine/Degludec, OD: decrease the dose. Take at iftar. Decrease dose by 15-30%.
• Long- or intermediate-acting basal insulin, NPH/Detemir/Glargine, BID: take usual morning dose at iftar. Decrease evening dose by 50% and take at suhoor.

The two lines differ in more than the count. Once daily basal moves whole to iftar with a 15-30% cut; twice daily basal keeps its usual morning dose at iftar and takes the 50% cut out of the evening dose, which then moves to suhoor.

Prandial and premixed insulin

• Rapid- or short-acting prandial/bolus insulin, Actrapid/Lispro/Aspart/Glulisine: decrease the dose. Take normal dose at iftar. Omit lunch dose. Decrease suhoor dose by 25-50%.
• Premixed insulin, OD: no change. Take normal dose at iftar.
• Premixed insulin, BID: decrease the dose. Take usual morning dose at iftar. Decrease evening dose by 25-50% and take at suhoor.
• Premixed insulin, TID: decrease the dose. Omit lunch dose, adjust iftar and suhoor doses.

Once daily premixed insulin is the single line in Table 3.6 marked no change; every other line either cuts a dose or omits one.