INS and diabetic ketoacidosis: Diabetic ketoacidosis is associated with an absolute lack of insulin and includes blood glucose levels usually > 250 mg/dL (13.9 mmol/L) accompanied with pH levels dropping below 7.3 and/or bicarbonate levels <18 mmol/L (15).It was shown that the rate of hypoglycemia during Ramadan fasting was 23.8─29.3% depending on the type of insulin therapy (16); however, most concerning, the rate of severe hypoglycemia was 7.1% for those using multiple daily insulin injections (MDI).