Diabetes Care: The Challenges of Fasting and Feasting

At AACE 2017, Shashank Joshi, MD, Lilavati Hospital and Research Centre, Mumbai explained his team’s simple diabetes treatment formula: A for A1C, B for blood pressure, C for cholesterol (LDL cholesterol), and D for diet that’s culturally sensitive and adaptable.

Joshi also reiterated that several countries experience fasting and feasting, and highlighted a presentation by Osama Hamdy, MD about the idea for an algorithm for Ramadan, which is a “feasting.” According to Joshi, all sects (Jews, Hindus, Muslims, or Catholics) have some amount of fasts that are followed by feasts. However, fasting for a diabetic could be deleterious, because he could have very low or high sugars. “Therefore it’s important to appropriate and have recommendations for fasting and feasting behavior and ensure that we adapt local customs and local cultural inputs into the day-to-day management of diabetes. “

Exercise is also necessary; South Asians often have weak muscles, and are recommended to complete 60 minutes of exercise every day including muscle-strengthening exercises compared to “Caucasian counterparts” who could just do a jog or a run and for 30 minutes, 3 times a week.

Joshi stressed that personalized diabetes care is a holistic approach, keeping patients at the center of the universe — “the DNA of this whole trans-cultural metrics.”

There is hope for diabetes patients; there are many new treatments on the horizon both digital and pharmaceutical. The team is looking at molecular mimics that will improve the insulin-signaling pathway and many nutrients modulate that. While they have yet to close the loop for the artificial pancreas, they are almost there, and have a better use of ensuring digital technology and using big data for meaningful digital making with patients.

The current philosophy of diabetes management is that patients should live happily with diabetes. “We are still in the search for oral insulin, it’s still elusive for the type 1 diabetic patients, but the artificial pancreas loop is almost closed, and I’m sure in a couple of years we’ll have good hope for those with type 1 diabetes. As far as type 2 diabetes is concerned, we have better molecular targets, which we can address, and I’m sure we will be able to get there better,” Joshi concluded.