Fasting & Diabetes: Considerations & Tips For Ramadan Fasting
Diabetes and Ramadan
Ramadan fasting takes place in the ninth month of the lunar calendar and lasts between 29-30 days. The holy month of Ramadan is the ninth lunar month and begins with the appearance of the moon at the end of Sha’ban (eighth month in the Islamic lunar calendar). During this month, it is mandatory for all the believer of Islam to keep fasting from the beginning of the sun until sunset.
Who should consider fasting during Ramadan?
Ramadan fasting is obligatory upon every adult Muslim, male or female, who has reached puberty, is sane and who is not sick or traveling. As far as women are concerned, they must be out of menstruation and the puerperium. Therefore, the mentally ill, neither the minor, nor the woman during menstruation or puerperium should not fast, as well as the pregnant woman, the woman who is Breastfeeding that fears for your little one, nor the weak old.
If you’re a diabetic person, fasting increases metabolic risks by excessively stimulating glycogenolysis and lipolysis, leading to the creation of ketone bodies. Ketone bodies besides acting on lipoprotein lipase, increasing LDL, increasing protein catabolism, are generators of ketone bodies and risk of ketoacidosis.
Although patients with clinical problems who are fasting and with diabetes may be exempt from it, many people decide to celebrate it.
The International Diabetes Federation (IDF) revealed that, in 2017, 17.3% of the UAE population between the ages of 20 and 79 have type 2 diabetes.
Who is at lower risk of complications if they follow Ramadan?
- Good control with diet or hypoglycemic agents
- No intercurrent infection
- Without chronic complications.
For which diabetic individuals is it discouraged to follow Ramadan?
- Severe hypoglycaemia or frequent or not renewed by the patient
- Recent debut
- Insulinized
- Poor metabolic control
- Intercurrent infection
- Chronic complications
- Pregnancy
- Lactation
- Gestational diabetes
- Elderly
What guidelines should be followed?
It is always necessary to individualize the care plan.
The attitude will be different depending on the type of treatment being performed, the degree of control of the disease or the personal characteristics of each patient.
- Frequent monitoring of blood glucose is the best measure to prevent most complications that may occur during Ramadan fasting. The frequency of the monitoring will also depend fundamentally on the degree of control and the type of treatment carried out.
- Nutritional recommendations: The Islamic cuisine abounds in sweet dishes and jams, rich in simple and complex carbohydrates accompanied by drinks and sweet juices. The patient with diabetes should avoid foods rich in fast-absorbing carbohydrates and fats.
- HC complexes at dawn and simple HC at night should be recommended
- It is necessary to break the fast provided that the capillary blood glucose is less than 60 mg / dL or higher than 300 mg / dL.
- Always ensure proper hydration
- It is advised that you bring glucose to treat hypoglycemia
- It is necessary to break the fast as long as the capillary blood glucose is less than 60 mg / dL or higher than 300 mg / dL
What dietary advice should be followed?
- Try to take suhur (breakfast) immediately before sunrise, and not at dawn, to achieve a more regular distribution of food consumption
- Eat plenty of foods composed of complex HCs, such as basmati rice, chapati or naan
- Include fruit, vegetables, dhal and yogurt in both daily meals
- Limit the consumption of sweet foods during the iftar (night). Dates and juices are sources rich in sugar. Consume small portions of traditional dishes such as ladoo, jelaibi or burfi
- Avoid carbonated and sugary juices. Sugar-free soft drinks or sodas are recommended to quench thirst
- Sweeteners may be used if necessary. Juices and soups help maintain the balance of water and minerals
- Reduce portions of fried foods, such as paratha, puri, samosas, chevera, pakoras, katlamas and fried kebabs
- Use moderately oil in culinary preparations
- Take fresh fruit and nuts as a snack after dinner or before bedtime
- Try to prepare less hypercaloric meals
Can you do physical exercise during ramadan?
- Normal physical activity avoiding excessive physical exercise
- Several studies have shown that light-moderate exercise poses no danger to diabetics who fast
Diabetics treated with oral drugs:
1.1. Drugs that do not produce hypoglycemia:
Metformin, Acarbose, Glitazones, DPP4 Inhibitors.
In general you can give the whole dose in one shot (better at night) or divide it into two
1.2. Drugs that can cause hypoglycemia:
Sulfonylureas, glinides.
According to SU taps:
- Several shots a day of Sulfonylureas: reduce to 1-0-1 or better switch to YOUR afternoon pod (preferably Glycated delayed, as there is more experience during Ramadan)
- Morning monodose of Sulfonylureas: take the shot at night
Glinidas: take before meals.
Patients treated with insulins:
- Use delayed insulins type Glargine in a single dose per day (add total units) or Detemir two doses
- If it is necessary to use several doses of insulin, try not to fast or adjust it as follows:
Pattern to two daily doses with frequent self-tests
- The dose administered in the morning is spent whole to the night before dinner.
- The dose administered at night is divided in the morning.
Examples:
Insulin NPH 20-0-10 → Insulin Glargine 0-0-30 (or NPH 5-0-20)
Insulin mixed 30/70 20-0-10 → Insulin mixed 30/70 5-0-2
There are over 1 million people living with diabetes in the UAE, placing the country 15th worldwide for age-adjusted comparative prevalence.
Rapid economic growth, sedentary lifestyles and unhealthy diets characteristic to the UAE are all risk factors, leading to the number of people with diabetes expecting to double to 2.2 million by 2040. However, an increasing population and a greater understanding of the condition among the communities have also contributed to the increase in patients diagnosed with diabetes.