Diabetes & Ramadan: Fasting The Right Way

DIABETES & RAMADAN:

FASTING THE RIGHT WAY

With the holy month of Ramadan here, fasting (as prescribed) in the month may be somewhat tricky for those suffering from diabetes. Dr. Mahir Khalil Jallo, Clinical Professor/Consultant Internal Medicine & Endocrinology reveals how individuals suffering from diabetes can fast safely in order to maintain optimal health.

Health conditions

Fasting in Ramadan can usually be accomplished safely, says Dr. Jallo. “However, in individuals with health conditions, it’s best to consult a doctor who will determine if the individual will be able to fast safely, especially if he/she are taking any medications as it is not safe to skip these during fasting hours,” he says. “Always remember, if you feel unwell during a fast, try to rest, consider sipping some juice, and consult your clinician if your symptoms do not improve.”

Chronic medical issues

Fasting is not meant to create excessive hardship on the Muslim individual. Some patients with diabetes fall under the exempted category because their chronic metabolic disorder may place them at high risk for various complications with marked alteration of the pattern and amount of their meal and fluid intake, says Dr. Jallo. “If they insist on fasting during Ramadan, they are creating a medical challenge for themselves and their physicians.” These risks include hypoglycemia, hyperglycemia, DKA and dehydration. He points out that physicians must quantify these risks and stratify each individual accordingly. “With the correct guidance, many people with diabetes can fast during Ramadan safely, but they must be under the close supervision of their care provider and made aware of the risks of fasting,” he says. “Individuals who fast against the advice provided by their healthcare professionals should follow expert and detailed guidance

to avoid the development of serious complications.”

Patient education

According to Dr. Jallo, studies have shown that the cornerstone of managing diabetes during Ramadan is patient education on fasting risks, self-glucose monitoring, nutrition, exercise, and medications. “Pre-Ramadan counselling reduces episodes of low blood glucose,” he says, and pre-Ramadan education is essential to remind people with diabetes about the importance of diet and exercise. Also, that regular glucose monitoring is essential to avoid complications, while reassuring them that this does not invalidate the fast.

Type 1 diabetes

Fasting in Ramadan for individuals with type 1 diabetes is generally associated with a high risk of hypoglycemia and hyperglycemia. “With well-structured education, the risks of fasting can be reduced, and suitable individuals can be allowed to fast under strict monitoring and after appropriate insulin dose adjustments with individualization taking in consideration pre-Ramadan diabetes control; previous Ramadan experience; availability of recourses; duration of the fast; the level of education; and the motivation for self-care,” he says.

Type 2 diabetes

In individuals fasting with type 2 diabetes, he advises a pre-Ramadan assessment is vital to evaluate the risks, educate the patient in self-management of the condition, and to produce a patient-specific treatment plan. “Individuals taking metformin, Sulfonylureas or insulin will need to make dose adjustments to reduce the risk of hypoglycemia,” he says, and individuals on multiple diabetes therapies will find themselves at a greater risk of hypoglycaemia, in this case, dose reductions will be required to accommodate for the increased risk of hypoglycemia. He suggests a post-Ramadan follow-up consultation is recommended to reassess treatment regimens and discuss fasting experiences during Ramadan. “In our practice, we notice that with the correct advice and support, most people with type 2 diabetes can fast safely during Ramadan.”

Important Tips to Help Muslims Adjust Safely to Ramadan Fasting

Stay hydrated. Breaking your fast at iftar with water ensures that you get the best source of hydration. Drink fluids several times throughout the night, those without caffeine.

Eat a variety of foods during the evening. Whole grains, vegetables, fruits, lean protein, healthy fat like olive oil and nuts nourish your body with all the healthy nutrients.

Remember always that portion size is important. Eating mindfully during Iftar gives you more energy than eating huge amounts all at one time.

For suhour (the pre-sunrise meal that helps blood sugar remain most stable and provides energy), some elements to include are whole grain cereal, whole grain bread and oatmeal. Also, fresh fruits, vegetables and protein from milk, yogurt, eggs, and nuts.

Keep moving. Though fasting can be physically exhausting, try not to be completely sedentary. Try to switch exercise to the evening after breaking the fast. H

Reference:

www.daralliance.org/daralliance/idf-dar-practical-guidelines-2021/