Diabetic hypoglycaemia during Ramadan fasting: A trans-national observational real-world study.

OBJECTIVES: To describe the risk of hypoglycaemia during Ramadan and determine its risk factors, and the impact of hypoglycaemia on patients' behaviour. METHODS: A cross-sectional multi-country observational study, with data captured within 6 weeks after Ramadan 2015. Patients' and disease characteristics and its management, the risk of hypoglycaemia and patients' response to hypoglycaemia were recorded. RESULTS: A cohort of 1759 patients; majority with type 2 diabetes mellitus from North Africa, Arabian Gulf, Saudi Arabia, and the Indian subcontinent. Hypoglycaemia was reported by 290 patients (16.8%); particularly affecting type 1 diabetes patients and in insulin-treated patients in general. Age was significantly younger in the hypoglycaemia group (P < 0.001). The commonest responses were reducing the dose or frequency of medications (42%), attending primary care providers (24.5%) or increasing monitoring (20.7%). Fasting was interrupted by 67% only of those who experienced hypoglycaemia and recourse to emergency services was pursued by less than a quarter of patients with hypoglycaemia. The country-wise analysis of the rates of hypoglycaemia was greatest in Egypt (51.3%) and lowest in Pakistan (3.5%). CONCLUSIONS: Hypoglycaemia is a significant complication of fasting during Ramadan. It may be predicted by type of diabetes, and use of insulin. Patients' responses are varied and call for more formal pre-Ramadan education.

Rasagiline-induced severe recurrent hypoglycemia in a young woman without diabetes: a case report.

BACKGROUND: We report a case of a patient with recurrent severe hypoglycemia after initiating the drug rasagiline (Azilect) for Parkinson disease. CASE PRESENTATION: A 25-year-old Emirati woman who had been diagnosed with Parkinson disease due to a genetic mutation since the age of 18 years presented to our hospital. She had been treated with a rotigotine patch 2 mg per day along with carbidopa + levodopa + entacapone 25 mg/100 mg/200 mg (Stalevo) over these years. Recently, her Stalevo had been changed to rasagiline (a monoamine oxidase B inhibitor). Soon after this change, she started experiencing recurrent documented severe hypoglycemia requiring hospitalization. Her hypoglycemic symptoms completely disappeared after 5-7 days of drug withdrawal. Despite detailed evaluation, no other causal relationship was documented except for rasagiline. CONCLUSIONS: To the best of our knowledge, this case report documents an unknown association between rasagiline and hypoglycemia.