With the month of Ramadan well under way, diabetics might be wondering how fasting is affecting their blood sugar control. This is a very important thing to consider, as a lack of food for long periods every day for a month will certainly affect your blood sugar levels, and in more serious cases, cause complications. In some situations, fasting might not be advisable for your condition, especially if you are at high risk for health problems. If you do not already know what they are, speak to your doctor and a nutritionist to educate yourself on the risks, and come up with a monitoring plan to manage your diabetes during the fasting month.
It is also best to listen to your doctor if she says that fasting is not recommended in your case.
Complications of fasting with diabetes
Patients with type 1 diabetes and improperly-managed type 2 diabetes fall into the group that are at high risk for complications if they fast. The main issues that can arise are:
This is when blood glucose readings are dangerously low, i.e. when your readings are 70mg/dl or 3.9mmol/l, and below.
This is the opposite of hypoglycaemia, where extremely high blood glucose levels of 200 mg/dl or 11.1 mmol/l, and above, are measured. Hyperglycaemia may cause diabetic ketoacidosis in type 1 diabetics.
- Diabetic ketoacidosis
Your body begins burning fat when the body’s cells are not receiving enough glucose to burn for energy. When this happens, the burned fat produces a by-product known as ketones, which can make your blood become dangerously acidic.
The risk of experiencing ketoacidosis is higher during the fasting month, as you would drastically reduce your insulin doses, based on the assumption that less is needed if you are not consuming meals during the day.
The lack of water and other fluids during the month of Ramadan will easily cause dehydration. Making matters worse is our humid tropical weather. Dehydration causes an increase in blood viscosity, meaning that your blood becomes thicker and stickier, which then raises the chance of blood clots, or thrombosis.
Diabetics who are either medically cleared or make an educated choice to fast during Ramadan should drink plenty of water during non-fasting hours in order to prevent dehydration and other complications.
Managing diabetes during Ramadan
Diabetic individuals who fast during Ramadan will have to be very disciplined in monitoring sugar levels, meeting nutrition requirements and maintaining exercise levels. Consider also, that not fasting, or doing a shortened version of fasting, is a wise management choice that is available to you. Checking your blood sugar levels throughout the day is highly recommended for fasting diabetics.
It is especially important for patients who use insulin. Testing of blood sugars should be done four times a day at these recommended times:
- Between 10am and 11am
- Between 3pm and 4pm
- Three hours after iftar
- Right before sahur
If symptoms of hypoglycaemia or hyperglycaemia occur, normalise your blood sugar levels by breaking your fast. Everyone should have a healthy and balanced diet during Ramadan, but it is even more important for diabetics, as well as pre-diabetics. Here are some tips on managing your meals during the Ramadan month:
- Consuming large meals at iftarand/or foods that are high in trans fat and carbohydrates should be avoided.
- Make smart cooking choices for meals, for example, bake, grill or steam, instead of frying.
- Begin meals with small portions of foods that are rich in simple carbohydrates in order to kickstart your metabolism in a positive way.
Foods like one or two dates are recommended.
- Time it so that you eat your sahurmeal as late as possible.
Eat complex carbohydrates like whole grains and oatmeal to help you stay full for longer and keep your energy reserve charged for more hours during a fasting day. If possible, avoid high carbohydrate foods altogether.
- Between iftarand sahur, consume between eight and 10 cups of water to stay hydrated.
- Dates are an important part of Ramadan, but for a diabetic, it is not a good idea to eat more than two in a day, as they are very high in sugar.
You can, however, begin iftar with one or two dates to normalise blood sugar levels. Exercising during fasting hours, especially before iftar, is not encouraged as it may lead to hypoglycaemia. People with diabetes are more likely to experience hypoglycaemia during the later hours of the fasting day. The ideal time to go for a workout is in the evening, an hour or two after you’ve had the iftar meal.
It is also a good idea to attend tarawih prayers as part of your daily physical activity routine during Ramadan. Fasting during pregnancy is controversial, because it is believed to carry a high risk for both the mother and her unborn baby.
You are exempt from fasting during Ramadan if you are pregnant. If any of the following apply to you, fasting is highly discouraged:
- Having experienced diabetic ketoa- cidosis or a hyperglycaemic coma less than three months before Ramadan
- Type 1 diabetes
- Poorly controlled diabetes
- Pregnant with gestational diabetes
- Chronic complications, such as kidney failure and heart attack
- Undergoing dialysis
This article serves as a guide for Muslim diabetics who wish to fulfil their Ramadan duties, but I strongly recommend you seek your doctor’s advice to determine if fasting is right for you. With these tips, I wish you a safe and healthy Ramadan filled with much time for reflection and family bonding!
BY DATUK DR NOR ASHIKIN MOKHTAR
Published in The Star Malaysia JUNE 12, 2016