Consensus on Insulin Dose Modification During Fasting in Type 2 Diabetes.

INTRODUCTION Fasting for patients with type 2 diabetes mellitus (T2DM) carries a risk of an assortment of complications. The decision of T2DM patient to fast should be made after sufficient discussion with physician regarding the risks involved. The current consensus is developed to help physicians manage T2DM patients during fasting. OBJECTIVE To provide simple and easily implementable guidelines on insulin dose modification during fasting in T2DM patients. METHODS The expert group committee discussed and proposed six recommendations for the use of insulin regimens during fasting. The recommendations were proposed on diet, exercise and categorization of risks during fast, breaking fast, dose modification of basal insulins, premix insulins and prandial insulins. All these recommendations were based on established guidelines and published scientific literature. These evidences were then factored into the national context based on the expert committee representative's patient-physician experience in their clinical practice and common therapeutic practices followed in India to successfully achieve optimal glucose control. The final consensus-based recommendations were proposed and collectively recorded for each insulin regimen. RESULTS Recommendations based on insulin dose modification during fasting in T2DM patients has been developed. Patients with diabetes, who fast are recommended to keep themselves hydrated, consume low glycaemic and high fibre food but, avoid sugary and caffeinated drinks along with fried foods. The main goal of insulin therapy during fasting is to provide adequate insulin to prevent post meal hyperglycaemia and prevent hypoglycaemia during fast. CONCLUSIONS We hope that the consensus based recommendations mentioned in this paper will be a useful reference tool for health care practitioners to initiate and intensify insulin therapy in T2DM patients in order to successfully complete fasting without much complication.