Diabetes and the Fasting month

Next week marks the start of Ramadan and for diabetics, there are special problems. Here are some articles taken from the Persatuan Diabetes Malaysia website. Whatever you do, please consult your doctor managing your diabetes for specific advice.

Diabetics need to exercise caution when fasting.

DURING Ramadan, Muslims all over the world perform their religious duty of fasting. For a healthy person, going without food and water in the day does not have many medical consequences. However, for diabetics, their blood sugar level may go haywire with the altered eating patterns.

A recent study of diabetes and its characteristics during the fasting month of Ramadhan, conducted in 13 countries with large Muslim populations, revealed that 40% of type-1 diabetics and 80% of type-2 diabetics fasted. Malaysia had the highest number of type-2 diabetics who fasted – 90%.

“The study showed that overall, severe hypoglycaemia increased five to eight times and hyperglycaemia went up three to five times during Ramadan,” said Dr Loke Seng Cheong, consultant physician and endocrinologist at Universiti Putra Malaysia.

Published in the American Diabetes Association’s Diabetes Care in 2004, the Epidiar study involved 13,000 diabetics. It also revealed that less than 50% altered their medication regime during fasting.

“The problem is most people go into fasting unprepared and deal with the risks as and when they occur,” said Dr Loke.

“There are many changes to the body as it adapts to a fasting stage. Some of the consequences of fasting include dehydration, and low or high sugar level, especially when breaking fast,” he said, adding that locally, doctors encounter many diabetic patients with problems when they fast.

Over-indulging when breaking fast is another problem.

and some helpful guides to Fasting and diabetes

The Koran mandates fasting during the month of Ramadan from sunrise to sunset. However people with diabetes do not have to fast during Ramadan (speak to your Imam about this).

Many people still wish to fast. Information in the articles below helps you to manage your diabetes safely, whilst fasting during this holy time as well as informing you about the possible dangers of fasting and diabetes.

Ramadan and diabetes

People with diabetes who take medicine to treat their diabetes, do not have to fast during Ramadan. You should speak to the Imam about this.

Dangers of fasting during Ramadan

Some tablets (sulphonylureas) and insulin can make your blood glucose (sugar) level go low (hypo). If you are not eating but are still taking this type of tablet or insulin, then it is more likely a hypo will happen.

Another danger is that you might become dehydrated (not enough fluid/water in your body). This can happen if your blood glucose level is too high (higher than 10mmol/l). Your body tries to lower the blood glucose level by passing urine (water). If you are not drinking (water and tea for example) because you are fasting, then the blood glucose level will get higher still and you can become very ill.

You must speak to your diabetes doctor or nurse before you fast. They can check how well your body is coping with the diabetes. If they are worried that your body is not coping very well, and there are signs of damage due to high blood glucose levels, then they may recommend you do not fast.

If you are unwell during the fast, you should test your blood glucose level. This is important as your level can be high or low and you will have to treat this.

If you have a clinic appointment during Ramadan you can change this for a better time for you to attend.

Make sure you speak to your doctor or nurse about this.

Changes to your diet

During Ramadan you have a very different routine for meals. It would usually mean you have two meals a day; the Sehri (early morning meal) which can be eaten as early as 04.00 and the Iftar (after sunset when the fast ends for the day). The Iftar includes large meals with lots of carbohydrate (starchy) food such as chapattis, and rice but also lots of sugary drinks. A lot of the food is fried. Because you do not eat for a long time, then eat a lot of food which the body changes to glucose, this means your blood glucose level will be low at some times and very high at others.

The following suggestions will help to stop this big change in blood glucose level:

• Do not eat so many sugary foods at Iftar. Only have small amounts of food such as ladoo, jelaibi and burfi.

• Eat more starchy food such as basmati rice, chapatti or naan bread to stop you feeling hungry.

• Have fruit, vegetables, dhal and yoghurt in your meals.

• Have your meal at Sehri just before sunrise and not at midnight. This will help to keep your blood glucose levels more evenly balanced.

• When you have a drink, have sugar-free drinks. These can be fizzy drinks or squashes. Drink water if you feel thirsty and do not add sugar to drinks. If you like a sweet drink then use a sweetener.

• Do not have too many fried foods such as paratha, puri, samosas, chevera, pakoras, katlamas, fried kebabs and Bombay mix. When using oil for cooking, be sure to only use 1-2 tablespoons (15-30 mls) for four people.

A lot of the food used to celebrate Eid-ul-Fitr can make your blood glucose levels rise and also make you put on weight. This is not good if you have diabetes. This does not mean you cannot have such foods, but you must be careful how much you eat.

Changes to your treatment

Diet only — people who manage their diabetes by what they eat and the amount of physical activity they do, should be able to fast during Ramadan. It is still important to monitor what you eat at the end of a fast as you should avoid eating too much sugary and fried food.

Medications taken for diabetics who choose to fast may need to be adjusted. Diabetics should discuss this with their doctors for individual medical advice.
Doctors who are interested may visit the Dobbs Forum thread Guidelines for management of diabetes during the fasting month