Safety and tolerability of once or twice daily neutral protamine hagedorn insulin in fasting pregnant women with diabetes during Ramadan

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Abstract

Aim: To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan. Methods: This was a prospective cohort study conducted during Ramadan 2006 and 2007. Twenty four pregnant diabetic women were given NPH insulin once at 5 pm or twice daily at 5 pm and 5 am. Demographic data, blood glucose control, insulin requirement, days of fasting and hypoglycemic episodes were analyzed. Results: Most women were parity 1 (37.5%) in their second trimester (54.2%) and worked during the daytime (87.5%). Fourteen women (58.3%) had gestational diabetes mellitus, nine women (37.5%) had type 2 and one (4.2%) had type 1 diabetes mellitus. There were significant reductions in mean fasting blood glucose (6.16 mmol/L versus 5.34 mmol/L, P = 0.001), glycosylated hemoglobin (HbA1c) (6.70% ± 0.91 versus 6.64% ± 0.96, P = 0.001) and serum fructosamine (232.4 mmol/L ± 24.0 versus 217.0 mmol/L ± 24.3, P = 0.001) after Ramadan compared to before Ramadan. Throughout the four weeks of Ramadan, home blood glucose monitoring showed a reducing trend and was within the acceptable limits. Insulin requirement was increased from the first to the fourth week with a reduction in insulin dose noted after (38.5 U/day) compared to before the start of Ramadan (40 U/day). Most women (79.2%) were able to fast for more than 15 days without any hypoglycemia or fetal demise. Conclusion: Once or twice daily NPH insulin is a safe and tolerable option for pregnant diabetics who wish to fast during Ramadan.

Original languageEnglish
Pages (from-to)132-137
Number of pages6
JournalJournal of Obstetrics and Gynaecology Research
Volume37
Issue number2
DOIs
Publication statusPublished - Feb 2011

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Isophane Insulin
Pregnant Women
Fasting
Safety
Insulin
Blood Glucose
Blood Glucose Self-Monitoring
Fructosamine
Fetal Death
Gestational Diabetes
Glycosylated Hemoglobin A
Second Pregnancy Trimester
Parity
Type 1 Diabetes Mellitus
Hypoglycemia
Hypoglycemic Agents
Cohort Studies
Demography
Prospective Studies
Serum

Keywords

  • Diabetes
  • Fasting
  • Insulin
  • Pregnancy
  • Ramadan

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

@article{92ea4a2c241b452ba7b9a816b6c3e0b7,
title = "Safety and tolerability of once or twice daily neutral protamine hagedorn insulin in fasting pregnant women with diabetes during Ramadan",
abstract = "Aim: To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan. Methods: This was a prospective cohort study conducted during Ramadan 2006 and 2007. Twenty four pregnant diabetic women were given NPH insulin once at 5 pm or twice daily at 5 pm and 5 am. Demographic data, blood glucose control, insulin requirement, days of fasting and hypoglycemic episodes were analyzed. Results: Most women were parity 1 (37.5{\%}) in their second trimester (54.2{\%}) and worked during the daytime (87.5{\%}). Fourteen women (58.3{\%}) had gestational diabetes mellitus, nine women (37.5{\%}) had type 2 and one (4.2{\%}) had type 1 diabetes mellitus. There were significant reductions in mean fasting blood glucose (6.16 mmol/L versus 5.34 mmol/L, P = 0.001), glycosylated hemoglobin (HbA1c) (6.70{\%} ± 0.91 versus 6.64{\%} ± 0.96, P = 0.001) and serum fructosamine (232.4 mmol/L ± 24.0 versus 217.0 mmol/L ± 24.3, P = 0.001) after Ramadan compared to before Ramadan. Throughout the four weeks of Ramadan, home blood glucose monitoring showed a reducing trend and was within the acceptable limits. Insulin requirement was increased from the first to the fourth week with a reduction in insulin dose noted after (38.5 U/day) compared to before the start of Ramadan (40 U/day). Most women (79.2{\%}) were able to fast for more than 15 days without any hypoglycemia or fetal demise. Conclusion: Once or twice daily NPH insulin is a safe and tolerable option for pregnant diabetics who wish to fast during Ramadan.",
keywords = "Diabetes, Fasting, Insulin, Pregnancy, Ramadan",
author = "{Mohamed Ismail}, {Nor Azlin} and Rohaida Adam and Sufian, {Seri S.} and {A. Wahab @ A. Rahman}, Norasyikin and Norlaila Mustafa and Kamaruddin, {Nor Azmi} and Jamil, {Muhammad A.}",
year = "2011",
month = "2",
doi = "10.1111/j.1447-0756.2010.01330.x",
language = "English",
volume = "37",
pages = "132--137",
journal = "Asia-Oceania Journal of Obstetrics and Gynaecology",
issn = "1341-8076",
publisher = "Blackwell Publishing Asia",
number = "2",

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TY - JOUR

T1 - Safety and tolerability of once or twice daily neutral protamine hagedorn insulin in fasting pregnant women with diabetes during Ramadan

AU - Mohamed Ismail, Nor Azlin

AU - Adam, Rohaida

AU - Sufian, Seri S.

AU - A. Wahab @ A. Rahman, Norasyikin

AU - Mustafa, Norlaila

AU - Kamaruddin, Nor Azmi

AU - Jamil, Muhammad A.

PY - 2011/2

Y1 - 2011/2

N2 - Aim: To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan. Methods: This was a prospective cohort study conducted during Ramadan 2006 and 2007. Twenty four pregnant diabetic women were given NPH insulin once at 5 pm or twice daily at 5 pm and 5 am. Demographic data, blood glucose control, insulin requirement, days of fasting and hypoglycemic episodes were analyzed. Results: Most women were parity 1 (37.5%) in their second trimester (54.2%) and worked during the daytime (87.5%). Fourteen women (58.3%) had gestational diabetes mellitus, nine women (37.5%) had type 2 and one (4.2%) had type 1 diabetes mellitus. There were significant reductions in mean fasting blood glucose (6.16 mmol/L versus 5.34 mmol/L, P = 0.001), glycosylated hemoglobin (HbA1c) (6.70% ± 0.91 versus 6.64% ± 0.96, P = 0.001) and serum fructosamine (232.4 mmol/L ± 24.0 versus 217.0 mmol/L ± 24.3, P = 0.001) after Ramadan compared to before Ramadan. Throughout the four weeks of Ramadan, home blood glucose monitoring showed a reducing trend and was within the acceptable limits. Insulin requirement was increased from the first to the fourth week with a reduction in insulin dose noted after (38.5 U/day) compared to before the start of Ramadan (40 U/day). Most women (79.2%) were able to fast for more than 15 days without any hypoglycemia or fetal demise. Conclusion: Once or twice daily NPH insulin is a safe and tolerable option for pregnant diabetics who wish to fast during Ramadan.

AB - Aim: To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan. Methods: This was a prospective cohort study conducted during Ramadan 2006 and 2007. Twenty four pregnant diabetic women were given NPH insulin once at 5 pm or twice daily at 5 pm and 5 am. Demographic data, blood glucose control, insulin requirement, days of fasting and hypoglycemic episodes were analyzed. Results: Most women were parity 1 (37.5%) in their second trimester (54.2%) and worked during the daytime (87.5%). Fourteen women (58.3%) had gestational diabetes mellitus, nine women (37.5%) had type 2 and one (4.2%) had type 1 diabetes mellitus. There were significant reductions in mean fasting blood glucose (6.16 mmol/L versus 5.34 mmol/L, P = 0.001), glycosylated hemoglobin (HbA1c) (6.70% ± 0.91 versus 6.64% ± 0.96, P = 0.001) and serum fructosamine (232.4 mmol/L ± 24.0 versus 217.0 mmol/L ± 24.3, P = 0.001) after Ramadan compared to before Ramadan. Throughout the four weeks of Ramadan, home blood glucose monitoring showed a reducing trend and was within the acceptable limits. Insulin requirement was increased from the first to the fourth week with a reduction in insulin dose noted after (38.5 U/day) compared to before the start of Ramadan (40 U/day). Most women (79.2%) were able to fast for more than 15 days without any hypoglycemia or fetal demise. Conclusion: Once or twice daily NPH insulin is a safe and tolerable option for pregnant diabetics who wish to fast during Ramadan.

KW - Diabetes

KW - Fasting

KW - Insulin

KW - Pregnancy

KW - Ramadan

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