How does the handbook recommend adjusting insulin therapy for patients with diabetes who are fasting during Ramadan?

The handbook recommends basal (long-acting) insulin as the preferred initial formulation, reducing the dose by 20% and taking it at iftar. Rapid-acting insulin doses should omit the lunchtime dose and be taken twice daily with the suhoor and iftar meals. For mixed insulin, consider reducing doses based on blood glucose readings and dietary patterns at iftar and suhoor.

Because insulin carries a high risk of hypoglycaemia during Ramadan fasting, the handbook advises specific adjustments. For basal or long-acting insulin, it recommends using this as the preferred initial formulation, reducing the total daily dose by 20%, and administering it at iftar, the sunset meal. For rapid-acting insulin, the lunchtime dose should be omitted, and the remaining doses should be taken twice daily with the meals at suhoor (pre-dawn) and iftar. For mixed or pre-mixed insulin, the guidance is to consider reducing doses, individualised according to blood glucose readings and the person's dietary patterns at iftar and suhoor. These changes are intended to minimise the risk of hypoglycaemia while maintaining reasonable glycaemic control across the fasting and non-fasting periods.