Nearly 1.5 billion Muslims all over the world celebrate the holy month of Ramadan. It is a matter of honour and dedication to observe the day long dawn to dusk fast during this time. Even though the Holy Quran allows exceptions for the sick, pregnant and elderly from fasting, it is estimated that nearly 79% of Diabetics all over the world still choose to fast as per their religious beliefs.
Even for a healthy adult staying without food and water for more than 12 hours can prove to be quite tedious. It is even more difficult during the summer months. So if you are diagnosed with diabetes and intend to fast this Ramadan, it is important to be aware of potential risks and measures that you can take to avoid them.
Understanding what fasting does in your body and what effect it has on Diabetes:
The Liver stores excess carbohydrates as glycogen. In healthy individuals during the fasting state, this glycogen is broken down to release glucose into the blood. Also, breakdown of fat occurs to release ketones in the blood which are used by the body as energy. This is usually sufficient to sustain them for 12 – 18 hours and their blood glucose levels remain within the normal range. Even though they may feel tired, their bodily functions are carried on normally.
In Diabetics this process is altered due to underlying insulin deficiency and medications. This causes complications like:
Hypoglycemia - sudden low blood sugar level (<70mg/dl as shown by your glucose monitor)
Hyperglycemia - very high blood sugar levels (>300mg/dl as shown by your glucose monitor)
Diabetic Ketoacidosis - very high levels of ketones in the blood making it more acidic (urine test is done to check for ketones)
Dehydration, low Blood Pressure and clotting of blood – More common in elderly diabetics with other complications like heart disease, previous stroke and kidney disease. Also seen more in summers, humid climates.
Pre- Ramadan medical evaluation, risk assessment and preparation:
If you are diagnosed with diabetes and wish to fast during Ramadan, plan ahead and schedule an appointment with your physician atleast 1 month prior. He/she will evaluate your overall physical health and may ask you to get these tests - your fasting and post breakfast blood sugars, your 3 month average blood sugars (HbA1c), blood cholesterol levels, kidney tests and any other tests that might be necessary.
Certain oral tablets and types of insulin are not recommended to be used during prolonged fasts. Your physician will review your medications, insulin injections and dosages and make necessary changes to prepare you for the fasting month. Also your diet and physical activity have to be changed if your blood sugars are found to be too high.
Based on your health and Diabetes control you could fall under any one of these risk categories.*Ask your doctor to know about your risk category.
Dietplanning and other important considerations for diabetes during Ramadan:
Invest in a home blood glucose monitor. It is a common misconception that skin pricking causes the fast to be broken. But studies have shown that people who regularly monitored their blood glucose levels had lower complications like hypoglycaemia and ketoacidosis. Regular home glucose monitoring is highly recommended.
Plan your predawn and after sunset meals to include whole grains, high protein foods like lean meat and fish, fibre rich vegetables and fruits, unsweetened dates and nuts. They take longer to be digested and stabilise the blood glucose levels over few hours.
Don’t skip the pre-dawn meal for any reason. Avoid fried foods, fatty foods, sweets, sweetened beverages and processed foods.
Drink plenty of water between dusk to dawn.
Take special care during the Taraweeh (night) prayers by taking more fluids, a starchy snack after iftar and checking your blood sugar levels.
Be aware of the symptoms of hypoglycaemia (<70mg/dl) – giddiness, shaking of hands, confusion, excess sweating, chest pain, black out. Break the fast immediately in that case.
Carry a small toffee, candy, chikki or a cereal bar with you at all times during the day and during the night prayers. They will come in handy if there is a sudden fall in your sugars and prevent you from losing consciousness. Remember, prolonged hypoglycaemia could be fatal.
In case of very high sugars (>300mg/dl) and if you experience ketoacidosis symptoms like fruity smell of breath and urine, abdomen pain, vomiting, severe weakness, giddiness, break the fast and seek medical help immediately.
Avoid strenuous physical activity
If you are diagnosed with High blood pressure and you are on medications for the same, invest in a home BP monitor and check your BP from time to time. Ask your physician regarding your BP medications. He/she may change the dosage and timing of medication if needed.
Post Ramadan medical review and medication adjustment:
Watch for high blood sugar levels and avoid overindulgence in sweets and sweetened beverages during the 3 day post Ramadan festivities.
Consult your physician to reassess your health and readjust your treatment back to the medications you were taking prior to Ramadan.
We hope this article helps you in observing a safe fast so you can immerse yourself in your religious duties without worry. Wishing all a safe and happy festival!
Ibrahim M, Abu Al Magd M, Annabi FA, et al Recommendations for the management of diabetes during Ramadan :update 2015 BMJ (British Medical Journal) Open Diabetes Research and Care 2015; 3:e000108. DOI: 10.1136/bmjdrc-2015-000108
Al Arouj and associates et al. Recommendations for Management of Diabetes During Ramadan American Diabetes Association work group report - Diabetes care vol28, 9 sep 2005; 2305-11