Can diabetic patients Fast with Diabetes?
Fasting during the holy month of Ramadan for diabetic patients, comes with a set of health precautions. Fasting can cause wide fluctuations in blood sugar levels, posing a medical challenge for diabetics with increased risk of complications. To fast in a healthy manner, adequate awareness, risk evaluation, diet and medication modification, and constant monitoring of blood sugar levels is essential.
Patients who exhibit one or more of the following are at a higher risk of diabetes-related complications during fasting:
- Type 1 diabetes
- Type 2 diabetes with poor blood sugar control
- Recent history of severe low blood sugar, or diabetic ketoacidosis. Diabetic ketoacidosis occurs when the body cannot produce enough insulin.
- History of recurring low blood sugar or unawareness of low blood sugar
- Conditions such as severe kidney disease or blood vessel complications
- Diabetic and pregnant
- Old age with ill health
- Acute illness
- People living alone treated with insulin
It is safer to fast with diabetes during Ramadan if one falls under the following categories:
- Well-controlled Type 2 diabetes
- Controlled diabetes with medications and/or lifestyle therapies
Ensure to consult a healthcare provider before you fast. They will help assess your risks. A healthcare professional may also advise against fasting if you are at a high risk of complications. If you choose to fast, your healthcare provider can share vital information with you about managing diabetes and adjusting your medications and/or insulin doses during the period of fasting.
Risk Factors
While the aim is to help diabetic patients fasting with diabetes without major complications, awareness of the possible complications is essential. This knowledge will help assess risks and identify symptoms of complications promptly.
Hypoglycemia
Hypoglycemia is a condition in which your blood sugar (glucose) level is lower than the standard range. If blood sugar becomes too low, hypoglycemia signs and symptoms can include looking pale, shakiness and sweating, irregular or fast heartbeat, headache and nausea, among others. For diabetic patients, fasting exponentially increases the risk of hypoglycemia. Precipitating factors include long fasting hours, missing Suhur, and failing to modify drug dosage and timing. Treat low sugar by rule of 15, ie 15 gms of carbohydrates. Examples of foods containing 15 gms of carbohydrates (are 4 ounces of orange juice, 4 ounce of non-diet soda or 4 glucose tablets). Recheck sugar in 20 minutes.
Hyperglycemia
Glucose tends to build up in the bloodstream for diabetic patients. This condition is called hyperglycemia. Fasting significantly increases the risk of hyperglycemia. Precipitating factors include lack of diet control during Iftar and excessive reduction in the dosage of diabetes medications due to fear of hypoglycemia.
Diabetic ketoacidosis
Diabetic ketoacidosis is caused due to excess buildup of ketones in the bloodstream. Ketoacidosis can be precipitated by lack of diet control during Iftar, excessive reduction in the dosage of insulin due to fear of hypoglycemia, acute stress, and illness or infection.
Dehydration and thrombosis
Diabetic patients can become dehydrated during long fasting hours. This can be exacerbated during summer and sweating during physical activity. Dehydration increases the possibility of coagulation and risk of thrombosis, which occurs when blood clots block veins or arteries.
Managing your health during fasting
To prevent complications from arising because of fasting, it is important to take adequate preventive measures and constantly monitor your health. The following recommendations are important:
Pre-Ramadan medical evaluation
Diabetic patients who wish to fast during Ramadan are advised to undergo an evaluation 1-2 months before the start of Ramadan to determine their health condition. In this evaluation, the healthcare provider can determine the patient’s knowledge about diabetes, diabetes self-management skills, and family support in case of complications.
The evaluation will also determine the risk of diabetes-related complications from fasting, and categorize it as very high, high, or moderate/low according to the criteria of the International Diabetes Federation. The feasibility of fasting is advised based on this risk categorization.
Monitoring blood sugars
Check sugars – just before iftar , 2 hours after iftar and 2 hours after suhur
Also check sugars when feeling ill
Dietary modification
All diabetic patients are encouraged to eat the pre-dawn Suhur on fasting days. They should maintain a balanced diet, with complex carbohydrates with slow energy release for the pre-dawn Suhur and simple carbohydrates for Iftar. Foods with a low glycemic index and high fiber content, such as high fiber cereals or oats, buckwheat, bulgur wheat or brown rice, are recommended. Foods high in saturated fats and sugars should be avoided.
Before starting the fast, drink enough sugar free and decaffeinated fluids to avoid being dehydrated. At the time of breaking the fast, it is advised to rehydrate with sugar free fluids. Sugary carbonated drinks or fruit juices are likely to raise blood sugar and make one feel thirstier. It is also advised to drink plenty of fluids between sunset and sunrise.
Exercise
Diabetic patients can perform their usual physical activity, including moderate exercise, but should avoid excessive physical activity especially towards evening hours to prevent hypoglycemia.
Adjusting diabetes medication
Your healthcare provider will help you adjust the timing, type, and dosage of your diabetes medication. The doctor will also help you adjust your insulin dosage and type, to mitigate the risks of hyperglycemia.
Breaking the fast
- if blood glucose < 60 mg /dl
- if sugar is < 70 in first few hours after suhur and the patient has taken insulin or oral medications like sulphonylurea at suhur
- if blood sugar is greater than 300 mg/dl
