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Supplemental injection training in person, virtually, or by phone

Insightful tips and tools to help you along the way

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Please fill in the form below to enroll in My Way Patient Support Program.

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<h2>Insulin dose adjustments for Type 1 Diabetes</h2>

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td>Premixed (analogue or conventional)&nbsp;&nbsp; &nbsp;</td>
 <td>
 <ul>
 <li>Move usual morning dose to Iftar</li>
 <li>Take 50% of pre-Ramadan evening dose at Suhoor</li>
 </ul></td>
 </tr>
 <tr>
 <td>CSII/Insulin pump</td>
 <td>
 Basal rate adjustment
 <ul>
 <li>Decrease 20–40% for last 3–4 hours of fast</li>
 <li>Increase 10–30% for first few hours after iftar</li>
 </ul>
 Bolus doses
 <ul>
 <li>Apply same principles as before Ramadan</li>
 </ul></td>
 </tr>
 <tr>
 <td>MDI (basal bolus) with conventional insulin</td>
 <td>
 NPH insulin
 <ul>
 <li>Take usual morning dose in the evening during Ramadan</li>
 <li>Take 50% of pre-Ramadan dose at Suhoor</li>
 </ul>
 Regular insulin
 <ul>
 <li>Evening meal dose remains unchanged - Take 50% of pre-Ramadan evening dose at Suhoor</li>
 <li>Skip afternoon dose</li>
 </ul></td>
 </tr>
 <tr>
 <td>MDI (basal bolus) with analogue insulin</td>
 <td>
 Basal insulin
 <ul>
 <li>Reduce dose by 30–40%</li>
 <li>Take at Iftar</li>
 </ul>
 Rapid analogue insulin
 <ul>
 <li>Reduce Suhoor dose by 30–50%</li>
 <li>Skip pre-lunch dose</li>
 <li>Adjust Iftar dose based on 2-hour post-Iftar glucose reading</li>
 </ul></td>
 </tr>
 </tbody>
</table>
CSII, continuous subcutaneous insulin infusion; MDI, multiple-dose injections; NPH, natural protamine Hagedorn Diabetes and Ramadan:&nbsp;Practical Guidelines International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. January 2021. Available at: <a href="http://www.idf.org/news/idf-dar-diabetes-in-ramadan%20guidelines" target="_blank">www.idf.org/news/idf-dar-diabetes-in-ramadan guidelines</a>

<h2>Insulin dose adjustments for Type 2 Diabetes</h2>

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td>Long/intermediate-acting (basal) insulin</td>
 <td>
 NPH/detemir/glargine/glargine 300/ degludec, once daily
 <ul>
 <li>Reduce dose by 15–30%</li>
 <li>Take at Iftar</li>
 </ul>
 NPH/detemir/glargine, twice daily
 <ul>
 <li>Take usual morning dose at Iftar</li>
 <li>Take 50% of evening dose at Suhoor</li>
 </ul></td>
 </tr>
 <tr>
 <td>Short-acting insulin</td>
 <td>
 <ul>
 <li>Normal dose at Iftar</li>
 <li>No lunch-time dose</li>
 <li>Reduce Suhoor dose by 25–50%</li>
 </ul></td>
 </tr>
 <tr>
 <td>Premixed insulin dosing</td>
 <td>
 Once daily
 <ul>
 <li>Normal dose at Iftar</li>
 </ul>
 Twice daily
 <ul>
 <li>Take normal dose at Iftar</li>
 <li>Reduce Suhoor dose by 20–50%</li>
 </ul>
 Three times daily
 <ul>
 <li>No afternoon dose</li>
 <li>Adjust Iftar and Suhoor doses</li>
 <li>Dose-titration every 3 days</li>
 </ul></td>
 </tr>
 <tr>
 <td>Insulin pump dosing</td>
 <td>
 Basal rate
 <ul>
 <li>Reduce dose by 20–40% in last 3–4 hours of fasting</li>
 <li>Increase dose by up to 20% early after Iftar</li>
 </ul>
 Bolus rate
 <ul>
 <li>Normal carbohydrate counting and insulin sensitivity principles apply</li>
 </ul></td>
 </tr>
 </tbody>
</table>
For unit-specific titration recommendations as determined by individual blood glucose readings, see Chapter 10 of the IDF-DAR guidelines. 
 degludec, insulin degludec; detemir, insulin detemir; glargine, insulin glargine; NPH, neutral protamine Hagedorn&nbsp; Diabetes and Ramadan:&nbsp;Practical Guidelines International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance. January 2021. Available at: <a href="http://www.idf.org/news/idf-dar-diabetes-in-ramadan%20guidelines" target="_blank">www.idf.org/news/idf-dar-diabetes-in-ramadan guidelines</a>

<h2>Oral Anti-Diabetic drugs (OADs) recommended dose adjustments</h2>

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td style="background-color: rgb(244, 242, 246);">
 Metformin</td>
 <td style="background-color: rgb(244, 242, 246);">
 Sulphonylureas</td>
 <td style="background-color: rgb(244, 242, 246);">
 Arcarbose</td>
 </tr>
 <tr>
 <td colspan="1" rowspan="4">
 Once daily
 <ul>
 <li>No adjustment usually required</li>
 <li>Take at Iftar</li>
 </ul>
 Twice daily
 <ul>
 <li>No adjustment usually required</li>
 <li>Take at Iftar</li>
 </ul>
 Three times daily
 <ul>
 <li>Take morning dose before Suhoor</li>
 <li>Combine afternoon dose with Iftar dose</li>
 </ul>
 Prolonged-release
 <ul>
 <li>No adjustment usually required</li>
 <li>Take at Iftar</li>
 </ul></td>
 <td colspan="1" rowspan="4">
 Once daily
 <ul>
 <li>Reduce dose for those well-controlled blood glucose</li>
 <li>Take at Iftar</li>
 </ul>
 Twice daily
 <ul>
 <li>No adjustment at Iftar</li>
 <li>Reduce Suhoor dose for those with well-controlled blood glucose</li>
 </ul>
 Older drugs e.g. glibenclamide
 <ul>
 <li>Should be avoided</li>
 </ul>
 Second generation sulphonylureas e.g. glicazide, glimepiride
 <ul>
 <li>Should be used in preference</li>
 </ul></td>
 <td>
 <ul>
 <li>No adjustment required</li>
 <li>Take at Iftar</li>
 </ul></td>
 </tr>
 <tr>
 <td>
 Thiazolidinediones
 <ul>
 <li>No adjustment</li>
 <li>Take with Iftar rather than Suhoor</li>
 </ul></td>
 </tr>
 <tr>
 <td>
 Short-acting insulin secretagogue 
 Three-meal dosing may be reduced/ redistributed to two doses</td>
 </tr>
 <tr>
 <td>
 SGLT-2 inhibitors
 <ul>
 <li>No adjustment</li>
 <li>Taken with Iftar</li>
 </ul></td>
 </tr>
 </tbody>
</table>

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <td colspan="2" style="background-color: rgb(244, 242, 246);">
 Incretin-based therapies</td>
 </tr>
 <tr>
 <td>
 DPP-4 inhibitors</td>
 <td>
 GLP-1 RAs</td>
 </tr>
 <tr>
 <td>
 No adjustment required</td>
 <td>
 No adjustment if appropiate dose titration prior to Ramadan (&gt;2–4 weeks before) has occured</td>
 </tr>
 </tbody>
</table>
Adapted from IDF-DAR Guidelines (2021)
For patients on multiple types of medication, please see Chapter 10 of the IDF-DAR guidelines
DPP-4, dipeptidyl peptidase-4; GLP-1 RAs, glucagon-like peptide-1 receptor agonists; SGLT-2, sodium-glucose co-transporter-2

Insulin and Other Medications Dose Adjustments for Type 1 and 2 Diabetes in Ramadan

OTHER-DIABETES-TOPICS

DIABETES

OTHER-CARDIOLOGY-TOPICS

CARDIOLOGY

Why Praluent is the Optimal Choice for Post-ACS Patients?

Explore the compelling reasons why Praluent should be your first choice for patients with recent acute coronary syndrome who need to achieve their LDL-C goals. This informative video provides in-depth clinical insights and evidence, detailing how Praluent’s unique mechanism of action and proven efficacy can significantly improve patient outcomes. The video also covers tips on the 3 main factors: efficacy, safety, and administration to help you to integrate Praluent into your treatment plans. Enhance patient outcomes and elevate your practice with Praluent.

<h2>Act now for your post-ACS patients to reduce their CV risk</h2>
<h3>After their first ACS event, patients are classified as very high CV risk by ESC/EAS 2019 guidelines, regardless of comorbidities.1</h3>
To address this elevated risk, the European guidelines now highlight early treatment with a PCSK9i as important for the management of dyslipidaemia.1
The approach of early treatment intensification with combined LLT is supported by strong clinical evidence, which demonstrates the benefit of early and prolonged LDL-C reduction for your patients and its impact on future CV outcomes.1,2

<h4>Patients are at immediate and elevated risk of a repeat CV event following their first ACS event2</h4>

of recurent CV events that occur in the first year post MI happen in the first 6 months1 
 (cumulative rate of MI, stroke and CV death of 13.3% and 18.3% at 6 and 12months,respectively)1*
 
 These very high-CV-risk patients require rapid LDL-C reduction to reduce their future CV risk.1,2

black

<h4>The earlier LDL-C is reduced, the greater the reduction in CHD risk3†</h4>

In meta-analyses of prospective epidemiologic studies and clinical data, the earlier LDL-C was reduced the greater the reduction in CHD risk.3†
In ODYSSEY OUTCOMES, early treatment with alirocumab demonstrated a significant 15% RRR in MACE (primary endpoint) in the overall population (HR 0.85 [95% CI 0.78, 0.93], P=0.0003), 2.0% ARR, and is the only PCSK9i associated with a reduction in all-cause mortality in a CV outcomes trial with only nominal significance by hierarchical testing (HR 0.85, 95% CI 0.73, 0.98).4,5
The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.5 The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).5

<h4>ODYSSEY OUTCOMES post-hoc analysis: relative risk reduction in MACE and all-cause mortality for patients with a first or recurrent ACS with arlirocumab vs placebo6‡¥</h4>
<ul>
 <li>Patients with first ACS &gt; n=15,921</li>
 <li>Patients with a recurrent ACS n=3,633</li>
</ul>

<h3>Median time to randomisation was 2.6 months6</h3>

MACE
alirocumab
vs placebo
Added to maximally
tolerated statins

7.4% vs 8.9%, respectively; HR 0.82 
 (95% CI 0.72, 1.05)

18.6% vs 20.5%, respectively; HR 
 0.90 (95% CI 0.78, 1.05)

Pinteraction= 0.34

All-Cause
Mortality
alirocumab vs placebo
Added to maximally 
 tolerated statins

3.0% vs 3.4%, respectively; HR 0.87 
 (95% CI 0.72, 1.05)

6.0% vs 7.4%, respectively; HR 0.84 
 (95% CI 0.64, 1.08)

Pinteraction= 0.81

This is a post-hoc analysis.¥
Following a first or recurrent ACS, alirocumab significantly reduced MACE and was associated with a reduction in all cause mortality.

<h2>This substantial clinical evidence demonstrates the importance of early treatment to reduce the CV risk of your very high-CV-risk patients.</h2>

Established atherosclerotic cardiovascular disease4
PRALUENT is indicated in adults with established atherosclerotic cardiovascular disease to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors:
- in combination with the maximum tolerated dose of a statin with or without other lipid-lowering therapies or,
- alone or in combination with other lipid-lowering therapies in patients who are statin-intolerant, or for whom a statin is contraindicated. ODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled phase 3 study.4,5 ~19,000 patients were randomised; all patients had experienced a prior CV event defined as myocardial infarction or unstable angina with 2.6 months median time post index event to randomisation.4,5 § ~90% were on high-intensity statins (atorvastatin 40 or 80 mg/day or rosuvastatin 20 or 40 mg/day).II The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.5 The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).5&nbsp;Consult the full prescribing information for further details:
*Jernberg et al.(2015) conducted an observational,retrospective cohort study that analysed data from mandatory Swedish national registries: the National Inpatient Register(inpatient admission and discharge dates, and main and secondary diagnoses according to International Classification of Diseases, 10th revision, Clinical Modification(ICD-10-CM codes); the Swedish Prescribed Drug Register (all drugs dispensed in Sweden; from 1st July 2005);and the Cause of Death Register ( complete nationwide coverage of date and cause(s)ofdeath).1&nbsp;A validation of the National Inpatient Register, where MI diagnoses recorded inpatient journals were compared with National Inpatient Register data, revealed that 95% of all MI diagnoses in the National Inpatient Register are valid.1&nbsp;All drugs were classified according to the Anatomical Therapeutic Chemical classification system.1&nbsp;Individual patient-level data from these registers were linked via the unique personal identification number, which was then replaced by a study identification number prior to further datap rocessing.1&nbsp;The data included 97, 254 patients admited to hospital with a primary MI between 1st July 2006 and 30th June 2011(primary MI) and alive 1 week after discharge.1&nbsp;20,567 patients experienced an event with in the primary composite endpoint of risk for non-fatal MI, non-fatal stroke or CV death with in the first 365 days post index MI.1&nbsp;The cumulative rate of the primary composite endpoint (MI,stroke or cardiovascular death) was 13.3% and 18.3% during the first 6 and 12 months, respectively, in the MI population.1&nbsp;Therefore, of the recurent CV events that occured in the first year post MI,those that happened in the first 6 months has been calclated as 13.3 / 18.3 x 100 = 72.6%.
†Data from a consensus statement from the European Atherosclerosis Society Consensus Panel assessing evidence from genetic, epidemiological and clinical studies. Log-linear association per unit change in LDL-C and the risk of CV disease as reported in meta- analyses of Mendelian randomisation studies (N=”194,427), prospective epidemiologic cohort studies (N=403,50”1), and randomised trials (N=”196,552). The proportional risk reduction (y-axis) is calculated as1-relative risk (as estimated by the odds ratio in Mendelian randomisation studies, or the hazard ratio in the prospective epidemiologic studies and randomised trials) on the log scale, then exponentiated and converted to a percentage.3
‡ODYSSEY OUTCOMES was a randomised, double-blind, placebo-controlled phase 3 study. ~19,000 patients were randomised; all patients had experienced a prior CV event defined as myocardial infarction or unstable angina with 2.6 months median time post index event to randomisation. Patients were randomised for 1 to 12 months after an acute coronary syndrome and had an LDL-C acute coronary syndrome and had an LDL-C ≥70 mg/dL or non-HDL-C ≥100mg/dL, or an ApoB of ≥80 mg/dL. ~90% were on high-intensity statins (atorvastatin 40 or 80 mg/day or rosuvastatin 20 or 40 mg/day). Background therapy: 96% aspirin; 88% P2Y12 inhibitor; 85% beta blocker; 78% ACE/ARBs.7&nbsp;The safety profile in ODYSSEY OUTCOMES was consistent with the overall safety profile described in the phase 3 controlled trials.4&nbsp;The only adverse reaction in ODYSSEY OUTCOMES occurring with higher incidence compared to placebo was injection site reaction (P&lt;0.001).5
¥Chiang et al (2021) conducted this prespecified analysis of the ODYSSEY OUTCOMES trial to determine whether a previous history of MI influenced the risk of MACE after ACS and the reduction of that risk with alirocumab treatment.6&nbsp;§Patients were randomised for 1 to 12 months after an acute coronary syndrome and had an LDL-C acute coronary syndrome and had an LDL-C ≥70 mg/dL or non-HDL-C ≥100mg/dL, or an ApoB of ≥80 mg/dL.5
IIBackground therapy: 96% aspirin; 88% P2Y12 inhibitor; 85% beta blocker; 78% ACE/ARBs.7

Abbreviations

References

Treat Early

DYSLIPIDEMIA

<h2>Identify the very high-CV-risk patients in your practice</h2>
Determining the CV risk of your patients can be complex, especially when taking into consideration multiple risk factors.1
However, for patients who have had an ACS, determining CV risk is simple:&nbsp;all patients who have had an ACS event are classified as very high CV risk, even if they do not have any additional comorbidities.1&nbsp;These patients may have been previously unidentified in your practice as very high CV risk and require urgent LDL-C management.1

<h2>Which of your patients are very high CV risk?</h2>
If we look at examples of the patients who may appear in your clinical practice, we can see a range of comorbidities and factors that contribute towards their CV risk:

Second MI 
 6 weeks ago 
 Age: 55 years 
 LDL-C: 112 mg/dL Polyvascular disease 
 (CAD &amp; PAD) Smoker 
 &nbsp;

First MI 
 12 months ago 
 Age: 63 years 
 LDL-C: 102 mg/dL Familial hypercholesterolaemia 
 Non-smoker 
 &nbsp;

First MI 
 6 months ago 
 Age: 63 years LDL-C: 130 mg/dL No additional comorbidities or family history of heart disease 
 Non-smoker

Hypothetical Patients
ESC/EAS guidelines definition of very high CV risk:1
<ul>
 <li>Documented ASCVD, such as previous ACS (MI or unstable angina)</li>
 <li>
 Other documented ASCVD via imaging, CT scan or carotid ultrasound</li>
 <li>
 DM with target organ damage, or ≥3 major risk factors, or early onset of Type 1 DM of long duration (&gt;20 years)</li>
 <li>
 Severe CKD (eGFR &lt;30 mL/min/1.73 m2)</li>
 <li>
 A calculated SCORE ≥10% for 10-year risk of fatal cardiovascular disease</li>
 <li>
 FH with ASCVD or with another major risk factor&nbsp;</li>
</ul>

<h2>Any history of ACS means your patient is at very high CV risk, regardless of comorbidities1</h2>
<h5>&nbsp;Do your post-ACS patients require intensified LDL-C management?</h5>

As many as 40% of the patients in your practice may be classified by ESC/EAS guidelines as very high CV risk1,2*

Following their first ACS event, these patients are at immediate risk of a repeat CV event if their LDL-C is not rapidly controlled3

51% of very high-CV-risk patients would not reach ESC/EAS LDL-C goals4†

<h3>Currently there is still a gap in management of very high-CV-risk patients, and further work could be done to optimise post-ACS patient care.1,4.</h3>

*Using the British Heart Foundation Heart and Circulatory Disease Statistics 2021 document, data was taken from inpatient episodes by main diagnosis in NHS hospitals in the United Kingdom and calculated using ESC/EAS 2019 guidelines criteria for patients at very high CV risk: 304,745 (coronary heart disease) + 135,670 (stroke) + 24,961 (transient ischaemic attack and related syndromes) / 1,182,753 (all heart and circulatory diseases) x 100 = 39.35%.2 †At 1 year post index ACS event based on a modelled LDL-C level of &lt;55 mg/ dL or greater on high-intensity statins and ezetimibe.4 The ELIPS study (NCT01075867) was a prospective, multicentre observational cohort study of consecutive ACS patients that aimed to assess the quality of care and adherence to recommended preventive treatments at four academic centres in Switzerland.4 The patient group contained 2,521 ACS patients enrolled between 1 January 2009 and 31 December 2017 who were alive one year after the index ACS event and had available data on LDL-C values and lipid lowering therapies.4

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