Diabetes Management During Ramadan!

What is Ramadan?

It is the ninth month of the Islamic calendar. It is the most sacred month for Muslim people. People observe the fast during the month from Sunrise till Sunset. Fasting during Ramadan is one of the five pillars of Islam.

Why it is important for doctors to know about it?

During this month there is a change in diet pattern, the timing of food intake, changes in the sleep pattern. These changes have different effects in healthy people and those with the disease. It’s very important to guide people with diseases during this month. Nearly 50 to 75% of people with diabetes keep fast during the month of Ramadan. Having proper knowledge will help in the proper management of diabetes in this high-risk group.

What are the health consequences of Ramadan fasting in healthy individuals?

Body weight typically decreases or remain stable during Ramadan.

• There are favorable effects on lipid profile.

• There is sleep deprivation.

What are the consequences in people with diabetes?

Without proper adjustments, the risk of getting low sugar(Hypoglycemia) increases. The weight remains unchanged. There is an increased risk of getting sugars high especially after Iftar. There is an increased risk of dehydration and thrombosis(blood clot formation).

Can the patient with diabetes do fast?

Yes and No. It depends upon the health of the patient and associated complications.

Depending upon the risk of complications your doctor may ask you to keep fast or not to keep fast.

The International Diabetes Federation & DAR alliance had formulated guidelines for managing diabetes during Ramadan.

According to these guidelines following, people should avoid fast-

1. Poorly controlled Type 1 DM

2. Pregnancy with Diabetes

3. Diabetes Pt. on Dialysis

4. Acute Illness

5. The Elderly who had Hypoglycemia

6. Patient with Heart Disease

7. Those getting low sugar without getting any symptoms (Hypoglycemic unawareness)

8. Those with recurrent Hypoglycemia

These people have a high risk of complications hence in these people we advise not to observe the fast.

However, if anyone with these risks wants to keep fast they have to be seen before the start of Ramadan.

Following people can keep fast- Type 2 diabetes well controlled on medicines.

However, people with diabetes should consult their doctor prior to starting fast.

Why people with diabetes should consult their doctor before the start of fast?

1. To know how safe is to keep fast.

2. To change medicine- dose, duration, timings

3. To get dietary advice

4. To know when to break fast and how to monitor sugars.

Is advice of not to keep fast anti-Islamic?

No. According to Islamic teaching people with the illness are exempted from keeping the fast. The guidelines which I have mentioned above have been approved by the religious head of Egypt.

What are the general instructions to the patients?

• Eat healthy - Avoid sweets. You can take fruits, vegetables and salad in plenty and dates(in limited quantity). Minimize the oil and deep-fried items.

• Don’t do vigorous exercise in the daytime - Tarawih prayers performed are a good exercise for the body.

• You may need to modify your medicines - You may have to check blood glucose with Glucometer.

• You have to break the fast if blood glucose is less than 70 mg/dL or is more than 300 mg/dL or acute illness develops or you get symptoms of Hypoglycemia.

Checking blood glucose breaks the fast-True or false?

False. Checking blood glucose doesn’t result in breaking of the fast.