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Managing Diabetes during Ramadan

Fasting In Ramadan

As many of you know, the religious ritual of As-Saum (the Fasting) is one of the 5 pillars of Islam. Muslims who fast during Ramadan must abstain from eating, drinking & use of oral medications from pre-dawn to after sunset; however there are no restrictions on food or fluid intake between sunset and dawn.

What happens to our body when we fast?

During a fast, at about 8 hours after our last meal our bodies start to use energy stores to keep our blood glucose (sugar) levels normal. For most people, this is not harmful but for diabetics, the body cannot use the glucose well. With diabetes, especially if you take certain tablets or insulin, you are at risk of hypoglycaemia or “hypos” (low blood sugar levels). Another challenge to face if you have diabetes is the risk of high sugars following the larger meals that you eat before and after fasting (at Suhur & Iftar), which can lead to health problems in the short and long term.

If one has Diabetes, the three major problems that can occur during Ramadan are:

  1. Low blood sugar levels (also known as Hypoglycaemia or hypos)
  2. High Blood sugar (Hyperglycaemia)
  3. Dehydration (Lack of fluids in the body)

What is Hypoglycaemia?

This is a low blood sugar level below 70mg/dl. If you get any symptoms of low blood sugar levels while you are fasting, you must stop fasting. If you have a blood glucose-monitoring machine, you must check your blood glucose (sugar) level and break your fast

Symptoms of Hypoglycaemia:

  1. Feeling sweaty
  2. Feeling dizzy
  3. Feeling anxious or unwell
  4. Trembling and shaking
  5. Tingling of the lips
  6. Going pale
  7. Palpitations.

You must treat Hypoglycaemia IMMEDIATELY with one of the following:

  1. 2 spoon of sugar diluted in 1 glass of water
  2. Sugar candy or Chocolate
  3. Glucose tablet or Fruit juice
  4. And next contact your health care provider.

What is Hyperglycaemia?

This is a high blood sugar level, above the normal range. If blood glucose exceeds 300mg/dl, break the fast and drink plenty of water. And next contact your health care provider.

Note: Blood glucose monitoring, through glucometer doesn’t invalidate the fast.  You need to test your blood glucose 2-4 hours after you begin fasting and then a few times during the day. You need to break your fast if your blood glucose levels fall too low or rise too high. Generally, levels below 70 mg/dL or above 300 mg/dL are considered unsafe.

Medically safe to fast During Ramadan

  • Stable Type 2 Diabetes
  • Stable Diabetes on oral medications
  • No severe hypoglycaemia or very high blood sugar
  • No Diabetic complications (Kidney, heart or Liver problems)
  • Stable insulin dosage with low fluctuations

Medically unsafe to fast during Ramadan

  • Patients with a history of recurrent hypoglycaemia (low blood sugar)
  • Poorly controlled Type 1 Diabetes (childhood Diabetes)
  • Acute illness (fever, diarrhoea, vomiting
  • Pregnancy with Diabetes
  • Patients with liver or kidney disease

Ideal Diet During Ramadan

Diabetes should consume light & nutritious food as the food intake in this period is only twice with long durations in between.

  • Avoid sugars, sweets, fruit juices, carbonated drinks & soda
  • For fluids, include buttermilk or lemon water (without sugar)
  • Avoid deep fried food & any refined flour (Maida) items like samosa, buns, bread, toast, rumali roti, naan roti and noodles.
  • Include whole grains like Oats, Jowar, Bajra, Ragi, Quinoa, multigrain, brown rice, and brown bread in meals.
  • Take lot of vegetables in form of salads or soup in Suhur and Iftar that are rich in fibre.
  • For protein, include healthy meats such as chicken, fish and eggs.
  • DO NOT skip your Suhur meal.
  • Break your fast with 1 date followed by 2-3 portions of low calorie fruits like apple, mosambi, orange, watermelon, papaya, guava, pomegranate, jamun, strawberry, cranberry, mulberry. Then followed by a cup of boiled dal or sprouts & 1 glass buttermilk or 1 cup veg raita with added spoonful of flax seed or chia seed.
  • Avoid high calorie fruits such as banana, grape, custard apple, chiku, pineapple & sugarcane.
  • Drink lot of water during non-fasting hours.

Note: It is necessary to continue your usual physical activity especially during non-fasting hours.

Conclusion

  • Majority of uncomplicated Type 2 diabetic patients can fast during Ramadan safely.
  • Pre-Ramadan medical assessment, education and motivation are very important to prevent diabetic related complications.
  • Patients should monitor their blood glucose even during the fast to recognise hypoglycaemia and hyperglycaemia.
  • Islam allows diabetics to have regular blood test (with glucometer) while fasting. If blood glucose is noted below 70mg/dl or exceeds 300mg/dl then break the fast.

🎉Wish you all in advance HAPPY RAMADAN!! 😁🌙



About the Author

Hajira Siddiqua
Dietician/Diabetic Counselor
MSc. Food and Dietetics, P.G Dip. Health Care Management
Certified Diabetes Educator
Executive Member of IDA (Telangana Chapter)
Ph. No. +91-9160872090

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