Impact of Socializing, Fasting and Feasting on Day to Day Blood Glucose Profiles in Diabetes Elucidated by the FreeStyle® Libre™ System

Abstract

Background: Total day-time fasting is observed by millions of adult Muslims during the whole lunar month of Ramadan. However, many people, particularly elderly men and women, do fast isolated or somehow consistent days outside Ramadan. This may pose clinical management challenges. Case Report: A case of an elderly diabetic man observing day-time Ramadan-type fasting on Mondays and Thursdays throughout the year is described. Detailed blood glucose (BG) profiles over a 10 week period were captured using the FreeStyle® Libre ™ Flash glucose monitoring system. Detailed study of these profiles revealed three distinctly different BG patterns every week. One pattern on the two fasting days (Mondays and Thursdays) with blood glucose peaking after dawn and after sunset with a downward trend throughout the day. A second pattern on Fridays with the BG levels that peak and remain high for a few hours in the early afternoon following the large and rich weekly family meal. The third pattern was seen on the remaining 4 non-fasting days where BG starts to rise in the midmorning reflecting the patient's life style of hosting and sharing with his business clients. Such detailed and visually presented information gave insights into his BG daily patterns enabling his therapeutic plans for hyperglycemia to be tailored on daily basis. Conclusions: This is the first documentation of glucose profiles during “Ramadan-type fasting” and feasting using the flash glucose monitoring system. In addition to detailed clinical and social history, use of medical technology may occasionally help resolve some difficult blood glucose patterns.

Rate, Timing, and Severity of hypoglycemia in adolescents with Type 1 diabetes during ramadan fasting: A study with freestyle libre flash glucose monitoring system

“…Only few studies reviewed glucose level fluctuation using CGM. [16][17][18][19][20][21] The use of CGM in our population uncovered the incidence of unrecognized hypoglycemia during fasting in adolescents with T1DM. [16] Al-Agha et al reported on the use of FGM system in children and adolescents with T1DM.…”

Glucose homeostasis during ramadan fasting: First case series illustrated by flash glucose monitoring and ambulatory glucose profiling

“…With these features, its place in clinical practice is getting more established in guidance by professional groups and experts (9)(10)(11).A positive impact on glycemic control associated with their usage in both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) has been reported (12) and their use seems to be expanding in emerging markets (13). Impact of socializing, fasting and feasting outside the month of Ramadan was recently demonstrated in a detailed report in this journal albeit on a single case (14).We are not aware of the use of AGP during the month of Ramadan itself. This is the first report using FGM and AGP to illustrate the changes in blood glucose levels during the month of Ramadan.…”

“…In addition to its novelty, this real world experience, albeit involving only a small number of subjects, comprehensively illustrated details captured on all aspects of glucose homeostasis make it particularly valuable. Since this use of this technology is expanding very rapidly, we should miss no any opportunities of learning about its advantages and limitations in the real world (12)(13)(14). A recent study from Germany highlighted how physicians valued the visual presentation of the glucose homeostasis data as AGP and set an example of similar studies in other regions (23).…”

“…However, it is heavily illustrated akin to a clinical and technical vignette to convey a clear educational messages to stimulate discussions. Obviously, we do not suggest that fasting patients should be changed to FGM outside its usual recommendations (9)(10)(11), however, we cannot ignore the fact that use of this technology is rapidly expanding in regions where nonfinger pricking methods may appeal to patients and it is www.ijmbs.org ISSN: 1947-489X timely that we learn about all of its aspects rapidly to acquire and evaluate our perceptions and clinical experiences (12)(13)(14)23).…”