The Holy month of Ramadan is here, this time in Summer. Fasting being part of this month for all those who follow Islam, it is pertinent for Diabetics who wish to fast to follow certain precautions in order to maintain their health and stay safe whilst fasting.
Firstly, it is important to remember that those with significant health problems such as poorly controlled Diabetes, Heart problems, Kidney problems and also pregnant women to not fast for health related reasons. Religious texts exempt individuals with Health issues, from fasting.
It is indeed necessary for all Diabetics who wish to fast to consult their Doctor few weeks prior to Ramadan month and check if they can safely fast during this month. It is also important to do necessary blood tests at the same time to check if those parameters are under control.
When we say fasting during Ramadan, we need to remember that the fasting hours can be long, for instance 4 am to 7 pm, during which it is not just foods that those who fast avoid, but also water. This means that they are prone to dehydration. Hence, the need to avoid hot weather and stay in cool places if one is fasting.
Usually Doctors go through the medication and adjust them as per the person’s Glucose control, considering other factors such as risk of low blood glucose with such Diabetes medication. It is worth reminding that all medications used to control blood Glucose can lower blood glucose which can be very dangerous if adequate precautions are not taken. Not taking food for several hours during the fasting period can predispose individuals to high risk of low blood glucose levels, and some medications have higher tendency than others to cause low blood glucose levels.
Oral medications like Metformin, Dpp4 inhibitors, Pioglitazone, Alpha Glucosidase inhibitors are the safer of the lot in terms of their lesser tendency to cause low blood glucose compared to others. Sulphonylureas which are commonly used to control blood glucose levels have a higher chance of causing low blood glucose and may need to be changed to safer alternatives. Another class of oral medication namely SGLT2 inhibitors have a lower risk of causing low glucose, but have other issues associated with their usage during fasting days, as they can cause dehydration and increase acid content in blood; which means that they are better avoided during the fasting days.
Coming to Insulin, the Insulin timings, doses and type of Insulin that is used may need changing during the fasting days. Newer Insulin analogues have a lesser chance of causing low blood glucose than the older conventional Insulin types. Those who are already on Insulin and planning to fast need to take extra care to avoid low blood glucose and also to prevent gross fluctuations in blood glucose levels. Moreover, Insulin dependent Diabetics should not stop Insulin on their own as that may lead to a dangerous Coma. Short acting GLP1 agonists are injectables used to control blood glucose levels and are safer medications when it comes to Hypoglycaemia risk i.e., the tendency to cause low blood glucose.
In those Diabetics who fast after their Doctor’s advice, they still need to be vigilant for any potential low blood glucose and check blood glucose using Glucometer in case of any concerns. This apart, more frequent blood glucose checks are recommended in order to monitor the trends and to seek medical attention as appropriate.
Food plays a crucial role in controlling blood glucose levels and more so during Ramadan. In general, both fasting and feasting are not recommended for Diabetics. But as fasting and feasting as part of festivities are common in this month, it is important to not overindulge in food, especially foods that are rich in fats and those that cause big surges in blood glucose. For instance, while breaking the fast in the evening, it is recommended to limit the customary dates consumption to one or two. It is not uncommon to observe that many put on weight due to the festivities by the end of the month.
It is recommended to use brown rice, low fat milk, millets, whole grain Atta to make Rotis, and limit the use of popular dishes like Biryanis, Haleem. While Fish and Chicken are fine, provided they are not fried, Red meat has to be avoided in view of the long term deleterious effects on health. It is also recommended to not consume too many Mangoes and other fruits. Fruit juices are a No No. It is worth discussing with a Dietician in detail about what, when and how much to consume, which to cut down and what to avoid.
Advance planning, education, counselling, awareness and individualisation stand as the key pillars to a safe and healthy Ramadan in those with Diabetes who wish to fast during this period.
