INS and diabetes mellitus: While the EPIDIR study, demonstrated increased risk of hypoglycemia, including severe hypoglycemia, and hyperglycemia/DKA in those with diabetes mellitus who fasted Ramadan (28), other studies reported better outcomes in those with T1DM who fasted Ramadan following Ramadan specific education (32), used analog insulin compared to human insulin (15, 33), or used insulin pumps (19, 20, 34).