Long Fast in Type 1 Diabetes; Feasibility and Safety

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-832
David M Strich*1, Renana Teomim2 and David Joseph Gillis3
1Shaare Zedek, Jerusalem, Israel, 2Hebrew University Faculty of Medicine, Jerusalem, Israel, 3Hadassah University Hospital, Jerusalem, Israel
Background: One of the important rituals of Jewish religious life includes refraining from food or drink from sundown to complete darkness the next day twice a year, i.e. on the fasts of Yom Kippur and the Ninth of Av. Therefore it is common for physicians to be asked by type 1 diabetics if fasting is feasible for them. Prolonged fasting is also required before some medical procedures. It is unknown how safe fasting is and what insulin dose should be recommended if fasting is acceptable. A previous study on this issue among type 1 diabetics was undertaken before the advent of modern short and long-acting insulin analogues. Other studies have looked at shorter fasts and/or at type 2 diabetics.  Objective: To evaluate: 1. the proportion of patients commencing a fast who are able to complete it. 2. The safety – in terms of hypoglycemia and hyperglycemia. 3. the optimal dosage of basal insulin to be recommended. Patients and methods: 57 type 1 diabetic patients were enrolled prospectively. 29/57 were insulin pump users and the rest were on multiple daily insulin injections. A total of 88 fast attempts were studied. Patients did not receive recommendations for insulin dose prior to fasting. Questionnaires were administered to these patients before and after each fast. Results: 78.4% of the fasts were completed successfully. No severe hypoglycemic episodes requiring external assistance were recorded Those who did not complete fasting did so because of mild hypoglycemia that they treated with oral carbohydrate  intake. Those who completed the fast took an average of 0.19±0.16 units/kg/day while those who did not complete the fast took 0.34±1.5 units/kg/day (p=0.0004). Conclusions: A 25 hour fast was safe for this group of type 1 diabetics. The optimal insulin dose appears to be around 0.2 units per kg for the entire fast. These data are of wider use than for religious fasts since refraining from oral intake is required prior to common medical procedures.  Type 1 diabetic patients can fast before such procedures if they use only basal insulin calculated at 0.2 units per kg body weight per day.

Nothing to Disclose: DMS, RT, DJG

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