A number of guidelines have emerged from recognition of these potential risks but it is worth emphasizing that these have been arrived at by consensus and few, if any, have been tested within the context of a clinical trial.Even the admirable structured education programme for individuals on oral therapy cited by the author has been subject to an observational evaluation only and did not apply to patients taking insulin.Nevertheless, I agree with the author that clinicians should ensure that patients at risk receive practical advice even if these are not evidenced- based. This might include:
• advising patients to be aware of the potential risk of severe hypoglycemia when fasting for Ramadan, and both those on insulin or sulfonylureas (and their families) must be able to recognize and confirm hypoglycemia with blood testing
• ensuring patients and their families are able to adjust and reduce insulin or sulfonylureas prior to a prolonged daytime fast
• explaining the consequences of a severe episode both to the patient and family and providing them with a glucagon kit and with training on how to use it in the event of a severe episode