As healthcare providers, we may be asked for advice from patients, caregivers or other healthcare team members regarding how to address medication taking behaviors safely during Ramadan.
Ramadan, which began on March 1 this year, is a month-long observance practiced by Muslims which involves fasting, worship and feasting, aimed at deepening faith, service to others, and improving personal relationships with God. For the duration of Ramadan, individuals refrain from consuming anything by mouth, including food, water, and medications during the daylight hours. Each day begins with Suhoor, a pre-dawn meal consisting of enough food and water to sustain the person for the entire day. At sunset, families break the fast together with a celebratory meal often rich in calories and fluids, called Iftar.
It is considered mandatory for all adult Muslims of sound mind and those physically able to tolerate it. While those who generally cannot safely perform fasting, such as elderly or chronically ill (e.g., diabetes) are exempted from fasting, Ramadan is the largest, most important celebration of the Muslim year, akin to the Christmas season for Christians. There is a often strong desire by many to participate in the fast, despite known risks, and some observers may choose not to disclose this to their healthcare providers. It is important for healthcare team members to ask patients if they plan to honor Ramadan by fasting.
The development of diabetes monitoring and treatment devices that utilize smartphone technology has been instrumental in changing the way we help patients monitor and treat their diabetes. As much as we may rely on this technology, it is even more important to our patients who depend on the information to remain safe once they leave their medical provider’s office.
Recently, the U.S. Food and Drug Administration (FDA) issued a news release about the possible risk of patients missing critical alerts on their smartphone-compatible diabetes devices. Normally patients can configure how they want to receive alerts from their continuous glucose monitors (CGMs), insulin pumps, and automated insulin dosing systems. Such alerts can include what types of alerts and messages they receive, when they receive them, and how they are sent to patients (ex. via audible, vibration, or text alerts). Recently the FDA identified an increase in reports being filed where patients who were using these monitoring and treatment devices were either not receiving safety alerts or were not hearing them despite having them setup to do so. These missed alerts included those involving severe hypoglycemia, severe hyperglycemia, and diabetic ketoacidosis. Not only did these events occur, they indicated it could have additionally led to death.
In addition to the labs that are considered “best practice” for all persons with diabetes, what OTHER labs do you find useful for diabetes management?
Clinical Pharmacy Practitioner in Primary Care
Mike Grunske, PharmD, BCPS
Mike Grunske is a Board-Certified Pharmacotherapy Specialist (BCPS). Mike transitioned his practice to the Clement Zablocki VA Medical Center where he has since practiced in the Primary Care Clinics as a Clinical Pharmacist Practioner. Within this role, his practice involves direct care and management of patients’ medication regimens. He has worked as an active preceptor for both pharmacy students and residents throughout his entire career. Mike is also Past-President and former Foundation Chair of the Pharmacy Society of Wisconsin (PSW).
Mike is married to a fellow PharmAid contributor (Vanessa Grunske). Together they have a teenage daughter and son. He enjoys traveling with his family, attending his kid’s cheer, baseball, and basketball events, and spending any available leftover time running and hunting.
Pharmacist at Advocate Aurora Health
Vanessa Grunske, PharmD, BCACP
Vanessa practices with Advocate Aurora Health in Milwaukee, where she sees patients at Aurora Sinai Medication Management Clinic and maintains a dispensing practice at St. Luke’s Medical Center. Board-certified in ambulatory care pharmacotherapy, her practice interests include diabetes, hypertension, smoking cessation, geriatrics, improving health literacy, and medication adherence. She particularly enjoys and spends a good share of her work hours teaching and mentoring pharmacy students, family medicine residents and pharmacy residents.
She and her husband, Mike, live in the Milwaukee area with their two teenage children. In her free time, she enjoys cooking, baking, visiting our national parks with her family or relaxing on a beautiful Caribbean beach.
Professor at Concordia University Wisconsin School of Pharmacy
Beth Buckley, PharmD, CDCES
Beth Buckley, PharmD, CDCES (Certified Diabetes Care and Education Specialist), is a Professor of Pharmacy Practice at the Concordia University Wisconsin School of Pharmacy, where she has a teaching role within all years of the curriculum with a focus on Applied Patient Care Skills Lab, Diabetes Pharmacotherapy, and electives in the areas of diabetes and wellness. Her current role is ambulatory care pharmacist where she works with a Collaborative Practice Agreement to provide chronic disease state management within a primary care clinic.
When not working, she enjoys reading, gardening, traveling with her husband, volunteering within the community, and active fun: hiking, biking, dog walking, practicing yoga, mindfulness, and living with intention and gratitude.
Disclaimer: The Wisconsin Academy of Family Physicians (WAFP) has entered into a business relationship with Pharm Aid to offer our members discounts and exclusive savings. This or other affinity program relationships presented by the WAFP in no way implies a WAFP endorsement of the program, supplier, or vendor.
