الفهرس 
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Abstract
Ramadan is a holy month for Muslims and fasting is one of the five pillars of Islam. The month lasts 29 to 30 days. During this time, the consumption of food and drink as well as oral and injected medication between dawn and dusk is prohibited.
Fasting is mandatory for all Muslim adults, with the exception of certain groups, e.g. those suffering from an illness. This may include some people with diabetes. Due to the metabolic nature of the disease, patients with diabetes are at particular risk of complications due to significant changes in food and fluid intake. Potential health risks include hypoglycemia, hyperglycemia, dehydration and acute metabolic complications such as diabetic ketoacidosis (DKA).
Despite the exemption, many people with diabetes practice fasting during Ramadan. It is important that the decision about fasting is made individually in consultation with the patient’s doctor, taking into account the severity of the disease and the associated risk. People with diabetes who are fasting are usually more susceptible to fluctuations in their blood sugar levels, depending on the type, composition and amount of food consumed, the regular use of medication, changes in daily physical activities or occasional binge eating after breaking the fast .
For fasting Muslims, the beginning of Ramadan heralds a sudden shift in meal times and sleep and wakefulness patterns.
Deprivation of sleep has been associated with reduced glucose tolerance compared to non-Ramadan periods.
In healthy people, an elevated blood glucose level stimulates insulin secretion after eating, causing the liver and muscles to store glucose as glycogen. During fasting, circulating glucose levels decrease and insulin secretion is suppressed. The secretion of glucagon and catecholamine is increased, which stimulates glycogenolysis and gluconeogenesis, which then leads to an increase in blood sugar levels.
Liver glycogen can deliver enough glucose to the brain and peripheral tissues for about l2 hours.
During Ramadan, each fasting period is often longer than l2 hours and can therefore be seen as a condition of intermittent glycogen depletion and repletion.
When glycogen stores are depleted and insulin levels are low, fatty acids are released from the adipocytes and oxidized to produce ketones that can be used as fuel by many organs and maintain glucose for the brain and erythrocytes.
Our present work aimed to evaluate the metabolic effects of Ramadan fasting on patients with Type 2 diabetes, and their relation to glycemic control, risk of hypoglycemia, as well as any possible effects on diabetic complications.
This study was conducted on 300 subjects with type 2 diabetes, assessed to evaluate the metabolic effects of Ramadan fasting regarding glycemic control, risk of hypoglycemia, as well as any possible effects on diabetic complications. The examination included measurement of body mass index (BMI), blood pressure, examination of the foot for sensory loss, and peripheral vascular disease (PVD), by assessing the vibration sense and calculating the ankle-brachial index (ABI) respectively. Laboratory tests were performed including fasting plasma glucose, HbA1c, complete lipid profile, serum creatinine, with calculation of eGFR, and urinary albumin-to-creatinine ratio (UACR).
The study showed a statistically significant difference between pre-Ramadan and post-Ramadan regarding BMI , Systolic , diastolic blood pressure ,TGs , eGFR.
The difference between pre-Ramadan and post-Ramadan was not significant regarding Vibration sense , ABI ,HbA1c ,LDL-C, HDL-C, UACR
According to minor hypoglycemia , Premix regimen was higher in hypoglycemia rate than Oral-Basal regimen (p<0.001*), than Basal plus regimen (p<0.001*), also than Basal Bolus regimen (p<0.001*).
SU–based oral therapy was higher in hypoglycemia rate than DPP-4- based oral therapy (p<0.001*).
Patients with HTN or dyslipidemia showed a higher Rate of Minor hypoglycemia than patient without HTN or dyslipidemia.
Regarding Sex and Smoking The difference was statistically non-significant according to rate of minor hypoglycemia.
According to of Severe hypoglycemia, Premix regimen was higher in hypoglycemia rate than Oral-Basel regimen (p<0.001*), than Basal plus regimen (p<0.001*).also than Basal Bolus regimen (p<0.001*).
SU–based oral therapy was higher in hypoglycemia rate than DPP-4- based oral therapy (p<0.001*).
Males and smokers showed a higher Rate of severe hypoglycemia than females and non-smokers. In addition, Patients with HTN or dyslipidemia showed a higher rate of severe hypoglycemia than patient without HTN or dyslipidemia.
Regarding Age (years) and Duration (days), there was a statistically significant positive correlation between rate of hypoglycemia with Age and Duration (days).
There was a statistically significant positive correlation between rate of hypoglycemia and BMI (kg/m2), Diastolic blood pressure (mmHg), FBG, HbA1c, LDL, TGs (Pre-Ramadan and Post-Ramadan).
Regarding Systolic blood pressure (mmHg), there was a statistically significant positive correlation between rate of hypoglycemia and Systolic blood pressure (mmHg) (Post-Ramadan).
Regarding ABI, HDL there was a statistically significant negative correlation between rate of hypoglycemia and ABI, HDL. (Pre-Ramadan and Post-Ramadan).
Regarding eGFR, there was a statistically significant negative correlation between rate of minor hypoglycemia and eGFR. (Pre-Ramadan). While, there was a statistically significant positive correlation between rate of Minor hypoglycemia and UACR. (Pre-Ramadan).