Managing Diabetes During Ramadan

Ramadan being a month of prayer and fasting is something all Muslims do and plan on following. However, fasting can have serious health complications on Ramadan prayers suffering from diabetes. Most diabetes patients are advised to not fast during Ramadan, especially since the fasting periods can easily extend from 12 to 16 hours daily (depending on where you are). Breaking the fast is also an issue, as the body’s reaction to the sudden inflow of sugars and food can affect your insulin levels drastically.

If you have got diabetes and you want to fast during Ramadan make sure you speak to your treating doctor so they can help you decide if it’s safe to do so.

Studies have shown that pre-Ramadan counseling reduces episodes of low blood glucose. Pre-Ramadan education provides a platform to remind people with diabetes about the importance of diet and exercise, and that regular glucose monitoring is essential to avoid complications, while reassuring them that this does not invalidate the fast.

A pre-Ramadan assessment with your doctor is vital if you are living with diabetes. Your doctor will support you to evaluate the risks, educate you on how to manage your diabetes during Ramadan, and work with you to produce a personal treatment plan to show you how to adjust your doses and fasting plan to complement Ramadan fasting hours.

If you are taking medication which lowers blood glucose – Consult your physician on whether or not it is advisable for you to fast, and what modifications are required to either the insulin or tablet regimen.

Do not stop insulin injections if you have Type 1 (insulin-dependent) Diabetes – Patients with Type 1 Diabetes need insulin in their bodies at all times, both night and day. Please talk with your doctor regarding how to adjust your doses and regimen for Ramadan. It may be that for the month of Ramadan, the type of insulin you use could change to be more suited to fasting.

Here are some few precautionary steps to follow for a safer fasting:

1. Individuals with diabetes who choose to fast during the Holy Month should obtain a medical assessment and specific advice on medication and dietary adjustments.
2. Be aware of the potential health risks related to fasting. Be ready to adhere to the recommendations of the healthcare team to achieve a safer fasting experience.
3. A medical assessment and educational counseling on physical activity, meal planning, glucose monitoring and dosage and timing of medications must be part of the process of preparing for Ramadan.
4. Those with poorly controlled diabetes, elderly patients who require insulin, children, and the acutely ill or frail are generally advised not to fast.
5. Fasting is also not recommended for pregnant women who need insulin and for the breastfeeding mothers, whether they have Type 1 or Type 2 diabetes. While most Type 2 diabetics are able to fast without complications, some dietary and medication adjustments are usually required.
6. Individuals with diabetes, both Type 1 and Type 2, who choose to fast should keep a watchful eye on their health and should monitor their blood glucose regularly and frequently.
7. The most significant health risks of fasting is the sever rise of the blood sugar level, symptoms of high blood sugar include frequent urination, increased thirst, headache, fatigue, exhaustion, blurred vision and lack of concentration. However, Low blood sugar level is another common risk of fasting and the symptoms include shakiness, sweating, hunger, nausea, confusion, irritability and lightheadedness. Being aware of these symptoms is important to avoid serious complications by seeking an immediate medical assistance.

Keeping Safe:

1. Always carry glucose treatment with you.
2. Always have diabetes identification, such as medical bracelet.
3. Test your blood regularly to monitor your glucose levels. This will not break your fast.
   • Before Suhoor: Your blood glucose targets should be 120-140mg/dl
   • Morning: Your blood glucose targets should be 140-180mg/dl
   • Midday: Your blood glucose targets should be 120-180mg/dl
   • Pre-Iftar: Your blood glucose targets should not be below 70mg/dl
   • 2 hours after Iftar: Your blood glucose targets should not be above 180mg/dl
   • At any time when there are symptoms of hypoglycaemia or hyperglycaemia or when feeling unwell
4. If your blood sugar level is high or low, you must treat this.
5. If your blood sugar level is high or low, you must treat this.
   • If your blood glucose level is below 4.0 mmol/l ( = 72 mg/dl ), end the fast immediately and treat the low blood sugar level.
   • If your blood glucose level is below 4.0 mmol/l ( = 72mg/dl ) at the start of the fast and you are on insulin or sulphonylureas ( or any other medication that can cause hypoglycemia ), don’t fast and treat your hypoglycemia right away.
   • If your blood glucose level is higher than 16.7 mmol/l ( = 300 mg/dl ), end the fast immediately.
6. 6. If you become dehydrated, end the fast immediately and have a drink of water.
7.  If you start to feel unwell, disoriented, confused, if you collapse or faint, stop fasting and have a drink of water or other fluid.
8. You should never stop your insulin, but you must speak to your doctor because you may need to change the dose and the times of your insulin injections.
9. If any of this happens speak to your diabetes team before fasting again.

Also Read: HEALTH TIPS DURING RAMADAN FOR PATIENTS WITH HYPERTENSION

Quick Tips:

1. Speak to your doctor and dietician if you are planning to fast.
2. Try to fast a couple of days in the month before Ramadan to see if you are capable of fasting without complications.
3. Make a proper meal plan approved by your dietician
4. Continue a varied and balanced diet.
5. Include more starchy carbohydrates and slowly absorbed foods.
6. Try not to have too many sugary and fatty foods.
7. Avoid overeating. Higher food consumption especially during Iftar and cause blood sugar to shoot up. Self control is the key.
8. Check your blood glucose levels more often.
9. Do not forget to take your medications
10. Be hydrated. Consume enough amount of water from Iftar to Suhoor
11. When you break the fast, make sure you drink plenty of sugar free and decaffeinated drinks to avoid dehydration.
12. Avoid stress. Always remember that stress aggravates everything
     

SPACE OUT YOUR MEALS

Remember, it is a good idea to pace your mealtimes during the non-fasting hours.

At Iftar, break your fast with a light snack such as dates and soup before Maghrib prayer. After prayer, have a main meal starting with a salad, followed by a balanced meal at Suhoor, just before Fajr and a snack in between if needed.

BALANCE YOUR MEALS

Choose low Glycaemic Index (low GI) food such as fresh vegetables and leafy greens, pumpkin, yams and butternut squash, sweet potato, as well as brown rice. Choose whole grains whenever possible

Avoid high Glycemic Index (high GI) food such as potatoes and white bread, juices, soft drinks, concentrated drinks, and cordials.

Control your portions and use the Ramadan Plate Method, which will be provided by your dietician, to make sure your meals are balanced.

STAY HYDRATED

Keep hydrated by drinking water from the time you break your fast until Suhoor to prevent dehydration.

Hydrate the smart way and eat fruits and vegetables high in water content such as strawberries, cucumber, celery, zucchini and tomato and vegetable soups

STAY ACTIVE

30 minutes of light exercise, such as brisk walking, after Iftar (Taraweeh) is recommended to keep the body active and your diabetes under control

Always monitor your glucose prior to any exercise and discuss any questions with your physician.

Frequently Asked Questions:

• What happens to my body when I fast?

When we fast, at about eight hours after our last meal, our bodies start to use energy stores to keep our blood glucose levels normal. For most people, this is not harmful. If you have diabetes, especially if you take certain tablets or insulin, you’re at risk of hypoglycaemia (or hypos for short) which is when your blood sugars are too low. With this year’s long fasts, the risks of hypos and dehydration are high. Another problem that can occur is the risk of high glucose levels following the larger meals that we eat before and after fasting at Suhoor (Sehri) and Iftar. Hypos, high glucose levels, and dehydration can be dangerous for people with diabetes.

• I have diabetes – can I fast?

We know that choosing to fast is a very personal decision. For some people with diabetes, fasting can be dangerous or cause problems to your health. People with certain health conditions like diabetes are exempt from fasting, especially if they use insulin or certain other medications. The same goes for anyone who has poor control of their diabetes or complications caused by diabetes like foot problems or damage to their kidneys or eyes.

• If you do want to fast make sure you speak to your GP, diabetes nurse or diabetes doctor before Ramadan starts.

Ramadan prayers can also be exempt from fasting if they:

• are children (under the age of puberty)

• are elderly

• are sick or have a certain health condition

• have learning difficulties

• are travelling

• are pregnant, breastfeeding, or menstruating.

• If you can’t fast

If you’re not able to fast, you can complete your duties by offering charity or providing food to the poor. Speak to your local Imam for more information about this. If you can’t fast this Ramadan, you might be able to make up the fast at a later date, perhaps during the winter months.

• Test your bloods during the fast

It’s really important to regularly test your blood glucose levels during your fast so you can check you’re keeping safe. This will not break your fast.

• Do I need to wake up for Suhoor (Sehri)?

Long hours without eating increase the risk of hypoglycaemia. It will be easier to balance your blood glucose levels through the fast if you eat a meal at Suhoor, just before sunrise, rather than at midnight.

• What types of food should I eat at Suhoor (Sehri)?

At Suhoor you should eat starchy carbohydrates which release energy slowly, such as multigrain bread, oat-based cereals, basmati rice together with beans, pulses, lentils, and fruit and vegetables. Other foods which will keep your blood glucose levels more stable through the fast include pitta bread, chapattis, and semolina. As with all meals, eat sensibly, don’t overeat, and remember to drink plenty of water.

• What types of food should I eat at Iftar?

Remember to eat sensibly and healthily all year round but also in Ramadan. Eating too much fried food and food high in fat and sugar will make you put on weight and raise your blood sugar levels and make them more difficult to control. Try to eat moderate portion sizes. Remember that Ramadan is also about self-control and discipline. If you have diabetes you can ask to see a dietitian who’ll be able to give you more advice about healthy eating.

• What types of drinks can I have?

Fasting can put you at risk of dehydration with long hours of fasting and also if you have high blood glucose levels. Drink plenty of sugar-free fluids, particularly water at Suhoor and after Iftar.

• Can I pray Taraweeh?

Taraweeh can be a tiring activity and you could become dehydrated or be at risk of hypos.

To avoid problems during Taraweeh, make sure you:

• eat starchy foods with Iftar as they are digested slowly

• drink plenty of water following Iftar

• take a bottle of water and glucose treatment with you to Taraweeh.

• What is diabetes?

• Diabetes is a health condition where the amount of glucose in your blood gets too high.

• This happens if your pancreas doesn’t make any insulin or enough insulin to help the glucose enter your body’s cells. Or the insulin it does make doesn’t work properly.

• Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it’s used as fuel for energy so we can work, play, and generally live our lives. It’s vital for life.

• Glucose comes from digesting carbohydrates and it’s also produced by the liver.

• If you have diabetes, your body cannot make proper use of this fuel so it builds up in the blood which can be dangerous.

There are two types of diabetes

Type 1

• Type 1 is when the body is unable to produce any insulin, which we need to break down the glucose (energy) in what we eat or drink.

• We don’t know exactly what causes it, but we know it’s not to do with being overweight. You can’t prevent Type 1 diabetes.

• It is usually diagnosed when you’re a child or young adult, although can occur in older adults as well.

• Approximately 10 percent of people with diabetes have Type 1.

Type 2

• Type 2 develops when the body cannot make enough insulin, or when the insulin produced doesn’t work properly.

• Your family history, age, and ethnic background affect your risk of developing it, and you’re more likely to get Type 2 diabetes if you’re overweight.

• It starts gradually, usually later in life, and because the symptoms may not be so obvious it might be years before you learn that you have it.

• If undetected, can lead to serious life-threatening conditions.

• Approximately 90 percent of people living with diabetes have Type 2.

COVID-19 and fasting with diabetes

The currently available epidemiological data shows that people who fast do not report higher rates of infections or hospitalization. There is therefore no evidence that fasting could lead to reduced immunity and higher risk for infection.

However, people with diabetes and complications, such as renal impairment or foot problems, are at high risker of infections. It is therefore important that they follow medical advice and do not fast to avoid increasing their risk of contracting COVID-19.

Following general Advice points are taken form Diabetes & ramadan International Alliance

1. Are People with diabetes more likely to get COVID-19?

There is not enough data to show whether people with diabetes are more likely to get COVID-19 than the general Population

2. Do People with diabetes have a higher chance of experiencing serious complications from COVID-19?

Yes. People with diabetes do face a higher chance of experiencing serious complications from COVID-19 

3. If diabetes is well-managed, the risk of getting severely sick from COVID-19 is not raised ?

• People with diabetes do face a higher chance of experiencing serious complications from COVID-19

Why?

• When blood glucose is raised, the risk is high is raised, because the ability of the body to fight off an infection is compromised
• The risk is even higher in those with diabetes-related complications such as heart disease, other vascular conditions or kidney problems.

4. In general, is it safe for a person with diabetes to fast Ramadan

• Generally, in most people with diabetes fasting doesn’t constitute extra risks to them.
• However, some people with diabetes should not fast as fasting could be a health risk for them.
• To know your risk of fasting Ramadan, follow your doctors instruction after careful assessment of your medical condition and your treatment.
• This risk of COVID-19 to diabetes patients fasting Ramadan is primarily related to two aspects:
  • Reduced ability of the body against infection due to high blood glucose
  • Reduced ability of the body against infection due to the presence of other medical condition such as heart disease or vascular disease or kidney conditions, etc.

5. Which groups, are at increased risk for fasting and are advised not to fast

The following groups are already considered as high/very high risk of fasting  and should be stressed upon to avoid fasting due to the added risk of COVID-19:

• Those with persistent high blood glucose
• Those with recent diabetic ketoacidosis or very high blood glucose
• Those with other medical conditions such as heart or kidney disease or foot infections
• Elderly people with diabetes and with generally poor health
• Those with acute illness (diarrhoea, vomiting, fever, etc.)

6. Diabetes, Ramadan and COVID19– Practical advice

STAY AT HOME

• Follow the general advice for COVID-19
• Medication adjustment according to your doctor advice
• Regular adherence to your other medications including your blood pressure, heart and cholesterol tablets, etc
• Avoid excessive intake of food or drinks rich in glucose and/or fat during Ramadan.
• Regular physical activity and light exercise
• Drink plenty of water for those with no heart or kidney conditions
• Regular monitoring of blood glucose during fasting as well as non-fasting hours.
• If blood glucose is persistently high, stop the fast, drink plenty of water, adjust the medication dose and consult your diabetes team.

References

Diabetes UK

International Diabetes federation