Many Muslim people with type 1 diabetes observe Ramadan fasting, despite the risk of hypoglycaemia that this can confer. Unlike oral medications, subcutaneous injections do not invalidate Ramadan fasts. This study sought to determine whether mini-dose glucagon injections were a safe and effective intervention to prevent and treat mild-to-moderate hypoglycaemia during Ramadan fasting.
In a 4-week crossover trial, 17 adults with type 1 diabetes who were fasting for Ramadan (daily fasting window around 15 hours) were assigned to use either glucagon or oral glucose tablets to treat hypoglycaemia, both for a 2-week period. Participants were trained to reconstitute and inject the glucagon (GlucaGen HypoKit, Novo Nordisk) at a dose of 150 µg for glucose levels 2.8–3.8 mmol/L and at 300 µg for levels 2.2–2.7 mmol/L. Corresponding oral glucose doses were 15 g and 30 g.
A total of 80 hypoglycaemia events that met the criteria for analysis occurred. The primary endpoint of blood glucose levels at 30 minutes after the hypoglycaemic event was significantly higher in the glucagon arm than the oral glucose arm (3.6 vs 2.5 mmol/L; P<0.001). Subanalysis showed that this difference was sustained in participants who had been fasting for more than 8 hours. Participants in the glucagon arm had a significantly greater time in target range (61.0% vs 55.1%), and significantly less time below range (5.8% vs 12.8%). No participant in the glucagon arm had to abandon their fasts, whereas 12% in the glucose arm had to stop.
No serious adverse events were reported. Nausea and injection site discomfort occurred in six of 17 participants; the nausea was intolerable in one individual.
Vinod Patel highlights the growing evidence base that lifestyle interventions are effective, and encourages persistence even though they can be difficult.
25 May 2023