[Diabetic patients in the Yom Kippur fast--who can fast and how to treat the fasting patients].

Jews all over the world fast on Yom Kippur, a fast lasting 25 hours. For diabetic patients and their physicians the fast is a significant challenge. The Jewish law exempts patients from fasting if the fast endangers the patient's health. In order to know if they can fast safely, many diabetic patients consult their physicians. In this review, the authors summarize the potential risk for fasting in diabetic patients and propose treatment protocols for patients who intend to fast. The principle recommendations are based on data related to fasting diabetic patients during the Ramadan fast, which is shorter than Yom Kippur. Furthermore, practical suggestions are based on a recent Israeli study on type 1 diabetic patients fasting for 25 hours, taking into account the Jewish law. Every diabetic patient who intends to fast should consult his physician for assurance that fasting is safe. The physician should pay special attention to patients on intensive insulin treatment or on sulfonylureas. Some, but not all these patients, should avoid fasting. In case these patients decide to fast, intensive monitoring of blood glucose is required during the fast to prevent severe hypoglycemia.