Diabates and Ramadan

This Blog is to provide information for people living with diabetes and who are thinking about fasting for Ramadan.

Talk to your healthcare provider about fasting in Ramadan

Before you decide to fast, it is vital to consult your healthcare provider to see your current diabetes status. This will help you understand the risk you can face during Ramadan, how to reduce the health risks and to know whether the risk is too high. Talk about your recent blood tests, diabetes medications and existing diabetes complications and the risks.

If you find out that your diabetes is not controlled before Ramadan then it is better not to fast this year.

Knowing all the facts will help in making a plan how to improve your diabetes and health over the next year. This will make you feel confident that you are working towards improving your health.

Risks of fasting

It is vital to discuss with your healthcare provider how diabetes and Ramadan fasting could put your health at risk. Understanding the risk is dependant on:

• Type of diabetes.
• Current status of your average blood sugar level (HbA1c) in a healthy range.
• Type of medication you are using for diabetes.
• As you are on medications it can put you at risk of low blood sugar levels (hypoglycemia)e.g. sulphonylureas and insulin.
• If you already have diabetic complications e.g. nerve damage, poor vision, Cardiovascular or renal complications. The risk that fasting could make these complications worse is high.

For example, individuals who have type 2 diabetes and manage it with lifestyle and diet only, or others who take one diabetic medication are not at risk of hypoglycemia so they will have a lower risk during the fast provided their Hb1ac is in a healthy range.

Make a plan for safe fasting

When discussing your risk of fasting it is important to have a safe plan after discussion with your health provider.

This include:

• Increasing blood sugar monitoring during Ramadan and be sure to have enough supplies for this. Blood sugar level testing does not break the fast, but you must break the fast if blood sugar levels are too low or too high.
• What to do if your blood sugar is too low or too high, or if you become unwell.

SICK DAY RULES

-Don’t panic, check with your diabetician for all your queries or if you are not sure about what to do.

-Do not stop diabetes medications, even you don’t feel like eating. There are few medicines that shouldn’t be taken much or you should stop altogether. Make sure you talk to your diabetician as soon as you feel sick for the right advice.

-Insulin dose may be needed to be decreased or increased when you’re sick, talk to your diabeticianin order how to manage your insulin doses during sickness.

If you do blood sugar testing at home you need to do it more frequently.At least four hourly, or as advised by your doctor, even during the night. If you are not testing blood sugar levels at home, be aware of hyperglycaemic signs.

Read this also: dua for fasting

Keep yourself hydrated

-If you have type 1 diabetes, checking ketone levels is mandatory if your blood sugar levels are above the target (above 14mmmol/l) and as advised by the dotor. Regardless ofyour blood sugar levels, if you feel sick, test for ketones and contact your doctor is they are positive.

-If you are taking SGLT2i tablet for your diabetes and feel sick or there is some infection, temporarily stop taking them. Check your ketones and your blood. There are different types of SGLT2i tablets so you need to know the brand name of the type you are taking. When you’re not sick these tablets can increase your risk of developing diabetic ketoacidosis so you need to be cautious to pick the symptoms.

-Keep eating or drinking. Try snacks or drinks with carbohydrates to get energy. Try sipping sugary drinks e.g. fruit juice, non-diet coke, lemonade or suck on glucose tablets. If you’re still not able to keep fluids down get help form your health provider as soon as possible.

• You may need a different type, or dose and need to know the best time to take your medications.
• Insulin adjustment. You won’t need much insulin before the start of the fast. Type of insulin may also need to be changed.

*Caution: pre-mixed insulin is not recommended during fasting. 

Blood sugar levels testing during fasting

Low blood sugar levels risks

Certain tablets or insulin, in fasting may increases the risk of low blood sugar levels (hypoglycaemia).

The signs and symptoms of hypoglycemia must be taken care of and test more frequently during Ramadan.

If blood sugar levels drop below 4 mmol/l, break your fast and treat your hypo with some sugary food or fluid and follow with some starchy food in order to protect your body. It’s a good idea to carry some hypo treatments and a bottle of water during your fasting time.

High blood sugar levels risks

During a fast if you miss your medication chances are high that you may develop high blood sugar levels in case you take larger portions of starch or sugary diet or if you are less physical activity. High blood sugar levels also increases the risk of dehydration which can make you dizzy and tired.

Consult to your diabetician about blood sugar levels

Before you plan to fast, ask your doctor or you what is a high blood sugar level. If it goes up during fasting, you must break and seek medical attention. Without medical help it can end up in diabetic ketoacidosis, a serious medical condition requiring hospital admission.

During Ramadan, healthier food and drink 

SUHOOR

Do not skip the suhoor meal, which is taken just before dawn. High fibre starchy meals e.g. oats and high fibre cereals, bulgur wheat, buckwheat or brown/ wild rice are slow absorbing, low glycemic index food. These help in the management of blood sugar levels in the healthy range while fasting.

Lentils, beans and chickpeas are good sources of protein and are rich in fibre. Pairing these them with vegetables and fruits help prevent constipation and are healthy for your heart.

Before starting the fast, drink enough sugar-free and decaffeinated in order to keep yourself dehydrated during the fasting period.

Important Guide: Fasting and Cholesterol 

IFFTAR; BREAKNG FAST

Traditionally the fast is broken with dates. Dates are high fibre but are rich in carbohydrate. Two large dates provide 20g of carbohydrate, which is the same as a slice of bread. Limit the number of dates to one or open the fast with water.

Rehydrate yourself with sugar free fluids. Water is the best option. For this purpose. Avoid fizzy drinks and fruit juices as they will raise blood sugar levels and make you thirstier.

Milk drinks e.g. laban are a good source of protein and calcium. Unsweetened laban is a healthier option.

The bakery is very tempting but is high in fat and sugar. Only a small pushes up blood sugar levels.

Take fried and oily foods in moderation as their frequent intake could lead to unintentional weight gain during Ramadan. These foods also affect heart health as they are richer in saturated fats and salt which increases blood cholesterol and blood pressure.