DIABETES: TIPS FOR SAFE FASTING DURING RAMADAN
DIABETES: TIPS FOR SAFE FASTING DURING RAMADAN
Ramadan
is the ninth month of the Muslim calendar, which is lunar based. Consequently,
the month of Ramadan changes each year on the Western calendar, as do the
number of hours of fasting, which depend on the length of the day.
The holy month of Ramadan (=Ramadhan)
2020 will begin on the evening of 23rd or 24th of April,
depending upon the visibility of moon.
I HAVE
DIABETES. CAN I BE EXEMPTED FROM FASTING DURING RAMADAN ?
According to the
Quran, diabetes is one of the situations that exempt a person from fasting
because of the risks involved. Fasting is not recommended for people with
diabetes. Nevertheless, the decision to fast or not during Ramadan remains a
personal choice.
You can follow certain healthy tips for fasting in Ramadan. Read:
CONCERN:
The main risks
associated with fasting are: hypoglycemia, hyperglycemia, diabetic
ketoacidosis (the presence of ketones in the blood) and dehydration.
Diabetics being
treated with insulin or those drugs for diabetes which act by
releasing the person’s own insulin [eg
Gliclazide (Diamicron® and Diamicron MR®), Glimepiride (Amaryl®),
Glyburide (Diabeta®), Repaglinide (GlucoNorm®)]are especially at risk. Likewise
are people with poorly controlled glycemia (blood sugar levels),
people with frequent hypoglycemic episodes and/or a severe hypoglycemia episode
in the preceding three months, and people who no longer feel the symptoms of
hypoglycemia. The presence of diabetes complications or an acute illness, as
well as some specific situations (e.g., someone’s physical job), also increase
the risks associated with fasting.
For fasting safely in Ramadan when you have diabetes, it
is essential to plan it with your doctor well in advance. Follow these basic
rules:
·
Eat your meals at the same times each
day
·
Avoid continuous snacking
·
Eat balanced meals
·
Drink lots of water
·
For Suhoor (the meal before sunrise),
eat foods that contain slowly absorbed carbohydrates (beans, bread,
rice, dal)
·
For Iftar (the meal that breaks the fast
after sundown), start with quickly absorbed carbohydrates (fruit, dates),
followed by foods containing slowly absorbed carbohydrates.
·
Avoid
high-intensity physical activity or exercise
·
Monitor
your blood sugar frequently
·
If
a problem arises, consult a doctor
Abandoning the fast
A diabetic who decides to observe Ramadan fasting must
recognize that certain situations might force him/her to stop fasting. Such a
situation is the occurrence of hypoglycemia (blood
sugar below 4.0 mmol/L) or significant hyperglycemia (blood
sugar above 16.5 mol/L).
Here are 8 tips for people with diabetes who are fasting in Ramadan:
1.
FREQUENT MONITORING OF BLOOD SUGAR LEVELS
It is essential that patients have the means to monitor their blood glucose levels multiple times daily. This is especially critical in patients with type 1 diabetes and in patients with type 2 diabetes who require insulin.
If you are diabetic and you
choose to fast during Ramadan, it is recommended you check your blood sugar
levels frequently throughout the day; this is especially critical for patients
who require insulin. You should check blood sugar levels at least
four times a day:
·
Between 10:00 am and 11:00 am
·
Between 3:00 pm and 4:00 pm
·
3 hours after Iftar
·
Directly before Sahoor
If
signs of hypoglycemia or hyperglycemia (low or high blood sugar) occur,
breaking ones fast is recommended in order to normalize blood sugar levels and
to prevent more dangerous complications.
A physician or diabetes educator can provide more details about controlling blood sugar during Ramadan and helping patients understand when it would be necessary to break their fast.
A physician or diabetes educator can provide more details about controlling blood sugar during Ramadan and helping patients understand when it would be necessary to break their fast.
2. BALANCED DIET
The diet during Ramadan should not differ significantly from a healthy and balanced diet. It should aim at maintaining a constant body mass. In most studies, 50–60% of individuals who fast maintain their body weight during the month, while 20–25% either gain or lose weight. Occasionally, the weight loss may be excessive (>3 kg). The common practice of ingesting large amounts of foods rich in carbohydrate and fat, especially at the sunset meal, should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing “complex” carbohydrates may be advisable at the predawn meal, while foods with more simple carbohydrates may be more appropriate at the sunset meal. It is also recommended that fluid intake be increased during nonfasting hours and that the predawn meal be taken as late as possible before the start of the daily fast.
A healthy and
balanced diet during Ramadan is recommended for everyone, but especially for
those who have diabetes or are pre-diabetic. Following the below tips is
recommended:
Consuming large meals at Iftar
and/or foods that are high in fat and carbohydrates should be avoided. Starting
meals with a small amount of food that is rich in simple carbohydrates and can
be absorbed quickly by the body, such dates or milk, is recommended.
Taking the Suhoor meal as late as
possible before the fasting time starts, and including foods that are rich in
complex carbohydrates, such as whole grain bread or vegetables, is also
recommended. Complex carbohydrates take more time to digest, absorb and ingest,
keeping the body fueled for more hours throughout the fasting day.
To know more about the helath benefits of fasting in Ramadan, read :
FASTING IN RAMADAN HAS THESE 9 HEALTH BENEFITS
3. WATER, WATER !!
Image by congerdesign
Try to drink adequate fluids (choose sugar-free fluids) during Suhoor and Iftar (sunset-meal) to replenish fluid loss during the day. Aim for 8 glasses a day.
The water intake does not increase during Ramadan.
Fluid is still lost gradually throughout the day as urine, through the skin and
when breathing and sweating, and our bodies gradually adapt during Ramadan so
that more water is conserved, ready for the next fast.
During
Iftar, it is important to drink plenty of fluids, and consume fluid-rich foods,
such as fruit, vegetables and soups. “The predawn meal, suhoor, provides fluids
and energy for the day of fasting ahead so it is important that enough fluids
have been taken in then
4. PHYSICAL ACTIVITY
Normal levels of physical activity can be maintained for most diabetics who choose to fast. However, excessive physical activity may lead to higher risk of hypoglycemia and should be avoided, particularly during the few hours before the sunset meal. If Tarawaih prayer (multiple prayers after the sunset meal) is performed, then it should be considered a part of the daily exercise program. In some patients with poorly controlled type 1 diabetes, exercise may lead to extreme hyperglycemia.
Although,
exercise during fasting hours, especially before Iftar, is generally
discouraged as it may lead to hypoglycemia. It is advisable to rest before Iftar;
however, people with diabetes are advised to avoid sleeping during this period
in order to remain alert to signs of hypoglycemia (which is more likely to
occur during the later hours of the fasting day).
Avoid rigorous exercise during fasting hours particularly by
persons on sulphonylureas or insulin.
5. DON’T SKIP SUHOOR !
You must not skip your Suhoor (pre-dawn) meal. Should you miss your Suhoor meal, you should not fast. Try to eat adequately for Suhoor.
Long hours without eating increase
the risk of hypoglycaemia. You must try to eat a meal at Suhoor just before
sunrise and not at midnight, as this will help to keep your glucose levels more
balanced through the fast.
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, do not over eat and
remember to drink plenty of water.
6. BREAK FAST PROMPTLY
Breaking of fasting should not be delayed. Al-Bukhaari (1957) and Muslim (1098) narrated from Sahl ibn Sa’d that the Messenger of Allaah (peace and blessings of Allaah be upon him) said: “The people will continue to do well so long as they hasten to break the fast.”
But Moderation
in eating is the key to good health. Avoid over-eating.
7. FOODS TO EAT
Image by Terri Cnudde
Limitation of sugary food items especially during the Suhoor meal. Inclusion of fruits, fresh vegetable salads without oily dressings, lentils, yoghurt, whole serial made food items, steam cooked or boiled vegetables with no or less of oils/fats, non-vegetarian items grilled or steam cooked instead of frying.
When the
hours of daylight of over at dusk the fasting period is broken until dawn. It
is important for people with diabetes to eat enough to keep nourished but to
keep to healthy foods.
Limit use of deep fried and oil rich food
items like paranthas, puris, pakodas, samosas, etc.
Carbohydrates provide a lot of energy but can be
less good for blood sugar levels, particularly for people with type 2 diabetes.
Carbohydrates with a low glycaemic index such as brown rice, full grain
bread and vegetables are better options than white rice, non-full grain bread
or potatoes.
Sweets may be popular dishes
at Iftar but are not good for blood sugar levels. If you wish to consume sweets
or ‘white carbohydrates’, it may be best to stick to much smaller portions of
these. If your blood sugar levels
become considerably raised as a result of these meals, it may be best not to
continue with the fasting.
Protein is a good source of energy and is more slowly absorbed than
carbohydrate. People with signs of kidney damage should seek the advice of their
doctor before significantly increasing the amount of protein they eat. Nuts, oily fish, avocados, olives and olive oil are excellent sources of
energy and they help to increase your HDL (good cholesterol ).
These options are a great way
to get the energy you need whilst keeping your blood sugar levels under
control.
8. MEDICATION
Patients who are well under control on diet and life style management do not need any changes in their daily physical activities. Avoid high calorie, high sugar, and deep fried oily food items especially after Iftar meals.
Type 1 diabetics who depend on
frequent doses of insulin, and experience extreme fluctuations in blood glucose
values, or are afflicted with hypoglycemia unawareness, or advanced micro or
macrovascular complications are medically advisednot to fast. Those type1
diabetics who are in good health, and have satisfactory control can fast safely
with basal-bolus insulin regime where once or
twice daily injections of intermediate or long acting insulin along with
pre-meal short acting insulin are used. NPH for basal and regular insulin for
bolus; and the insulin analogs detemir or glargine for basal combined with
lispro, glulisine or aspart for bolus have shown almost similar good results.
The newer analogues are equally effective as compared to traditional insulins,
while causing much less hypoglycemia. Insulin pumps used in carefully selected
educated type-1 diabetics could be very effective in enabling them to fast
safely in Ramadan.
Type 2 diabetics in good
health, with reasonably good diabetic control and free from advanced
complications, and requiring insulin alone or in combination with oral
medications, may undertake Ramadan fasting. Generally speaking, long acting
basal insulin is advised at Iftar times, and supplemented by short-acting
insulin at Suhur times. Short-acting analog before meals instead of the regular
insulin is reported to be associated with less hypoglycemia and smaller
post-prandial glucose excursions in diabetics fasting in Ramadan.
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