Clinical Case Study

Severe hypoglycemia in a Muslim patient fasting during Ramadan

Tahseen A Chowdhury

Diabetic Hypoglycemia October 2011, Volume 4, Issue 2: page 11-13

Abstract

A 56 year-old man with type 2 diabetes who had been fasting during Ramadan was admitted urgently through the Accident and Emergency (A&E) department with severe hypoglycemia. On arrival at his home, paramedics noted a capillary blood glucose level of 2.2 mmol/l. On admission to hospital, computed tomography of the brain showed evidence of a new right cortical infarct. A working diagnosis was made of acute stroke secondary to hypoglycemia, complicated by aspiration pneumonia. Intravenous glucose infusion and antibiotics were commenced, with no improvement in consciousness level. He was admitted to the stroke unit, and his condition improved significantly over a period of 10 days. He required rehabilitation on the stroke unit, but was discharged after four weeks with a residual mild left-sided weakness. This case illustrates the high risk of severe hypoglycemia in Muslim patients with diabetes who fast during Ramadan. When questioned, he stated that he was advised by his diabetes nurse not to fast, but had decided to do so anyway, reducing his insulin dose to what he thought was a safe level. It is recommended that all Muslim patients with diabetes undergo a pre-Ramadan assessment, and if deemed to be high-risk they should be advised not to fast. Those who plan to fast will require individualized advice on adjusting therapy when fasting for Ramadan.

Key words: hypoglycemia, diabetes, fasting