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Ann Saudi Med 28(4) July-August 2008 www.saudiannals.net 305 month in the CI group (P<.002). None of the patients developed sev vere hypoglycemia (defined as hyv poglycemia associated with coma or convulsion) or DKA during Ramadan fasting. One month prior to Ramadan, the mean frequency of simple hypoglycemia in the insulin pump group was 11 episodes per patient per month and the mean frequency of simple hypoglycemia in the CI group was 18 episodes (P<.001). Three adolescents on CI therapy had to break their fast durv ing Ramadan once or twice because of hypoglycemia. However, none of the insulin pump group broke their fast. All adolescents on insulin pump therapy had to adjust their basal rate insulin infusion to avoid hypoglycev mia prior to Ramadan fasting. Ten to 15% of the basal insulin infusion rate was reduced during the hours of fasting. One patient on insulin pump therapy suspended the pump for 2 hours to avoid hypoglycemia. The prevdawn insulin dose was reduced 10% to 20% in the CI group. The tov tal insulin dose requirement was 0.9 units/kg/day (range, 0.8v1.2) in inv sulin pump group in comparison to 1.1 units/kg/day (1.0v1.3) in the CI group. One unit of the ultravshort acting insulin lispro (Humalog) was required to cover for 10 grams of carbohydrates and one unit of lisv pro insulin was required to cover for 50 to 100 mg/dL of blood glucose above 100 mg/dL as a correction bov lus for high blood levels. Several reports indicated that fasting in Ramadan is safe for the majority of diabetic patients with proper education and diabetes management.4 Most type 2 diabetv ics can fast safely during Ramadan. Occasionally, patients with type 1 diabetes who insist on fasting durv ing Ramadan can also fast if they are carefully managed. In this study, the frequency of hypoglycemia was sigv nificantly lower in the CSII group. cose levels and the rate of hypoglyv cemic episodes were compared with those in 4 adolescents with type 1 diabetes who were on conventional insulin (CI) therapy. CI therapy is defined as two insulin injections per day, before breakfast and before dinner combining the intermediatev acting insulin (NPH) and the shortv acting insulin (regular). The patients on CI therapy were trained on the exchange program for diet therapy and also showed interest in fasting during Ramadan. All patients visv ited the clinic prior to the month of Ramadan to adjust insulin doses and they were instructed to check blood glucose more frequently, especially during the fasting hours. The recv ommended times for blood glucose checkvup were prevsunset meal, 2 hours after, prevdawn meal, 2 hours after, prevschool, after school and as needed. The patients included in the study had type 1 diabetes melliv tus for a mean duration of 7 years (range, 5 to 9 years). The age of the adolescents ranged from 15 to 19 years. They were followed on insulin pump therapy for a mean duration of 18 months. There was a significant reduction in HbA1c, mean blood glucose level and the frequency of hypoglycemic episodes in adolescents on insulin pump therapy in comparison to CI therapy during Ramadan fasting. The mean HbA1c was 7.8% (range, 7.1v8.9%) in the insulin pump group compared to 9.1% (range, 8.3v10.6%) in the CI group (P<.001). The mean blood glucose was 123 mg/dL (range, 72v 201 mg/dL) in the insulin pump group compared to 192 mg/dL (range, 122v394 mg/dL) in the CI group (P<.001). The mean frequenv cy of simple hypoglycemia (defined as blood glucose <60mg/dL) was 16 episodes (range, 12v29) per patient per month in comparison to 29 epiv sodes (range, 19v36) per patient per Insulin pump therapy during Ramadan fasting in type 1 diabetic adolesc cents

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