HYDERABAD: With the holy month of Ramadan approaching, the Muslim population around the world prepares to fast every day. Fasting during Ramadan is a personal choice and for healthy adults, a decision easier to take than for those who may have a chronic illness such as diabetes.
Even healthy adults sometimes experience short-term effects such as headaches, dizziness, lightheadedness, fatigue, low blood pressure and the inability to focus on certain attention-driven tasks. For people living with diabetes, there is a higher risk of managing these situations and most of all, ensuring that their blood sugar levels remain at a ‘healthy level’ throughout the fasting period.
The Ramadan fast ranges anywhere from 14 to 16 hours. Patients with diabetes need to have their meals at regular intervals which they cannot do if they are fasting for so long. Hypoglycemia, i.e. low blood sugar, is a common complication that arises when patients go for long periods without a meal. Other complications that could arise include compensatory hyperglycemia, dehydration and diabetic ketoacidosis.
People with diabetes who wish to fast during Ramadan should consult their doctor who can give them a personalized management plan to minimize such complications. Three key factors that can help patients experience a healthy Ramadan are:
Pre-fest health education
Every patient should be made aware of his or her specific diabetes case and the potential risks of fasting. Ramadan-focused diabetes education is necessary to give knowledge that helps to make informed decisions on how to manage diabetes through the whole month and during the daily fast. Patients must also be informed about blood glucose monitoring, nutritional do’s and don’ts, exercise, and medication adjustments.
Such an education plan also alerts when their medical situation requires breaking the fast. Doctors must be contacted if:
l One experiences symptoms of hypoglycaemia, hyperglycaemia or any other physical uneasiness
l One experiences strong headaches, excessive fatigue, blurry vision or a feeling of losing consciousness
A diabetes management plan
For patients with diabetes, therapeutic modification is the cornerstone of a good Ramadan management plan. The type of medication to manage diabetes can influence the risks that come with fasting and therefore needs careful attention and possible modification. If a diabetes patient is on insulin therapy, he or she might need lesser dose of insulin before the start of the fast.
Moreover, there may also be need to change the type of insulin used if patients choose to fast for Ramadan. Patients must visit their physicians about 6-8 weeks before Ramadan, and if needed, also consult a nutritionist. A doctor and nutritionist can provide the right guidance on medication and diet modification to manage the physiological changes brought on by fasting and ensure that blood sugar levels remain fully manageable during the fast.
Regular blood sugar monitoring
An increasing number of doctors now believe that patients with diabetes who wish to fast should check their blood sugar levels regularly through the day and during the entire month of Ramadan. Patients must consult their doctor if their blood glucose levels drop below 70 mg/dL (3.9 mmol/L) or rise above 300 mg/dL (16.7 mmol/L)For those living with diabetes, a condition that requires life-long management, it is easy to see why religious and medical recommendations allow exemption from fasting during Ramadan.
However, for many people, fasting is a deeply spiritual experience and they insist on participating. For this reason, it is important for doctors and patients to work together and plan well ahead for a healthy and safe Ramadan.
High risk groups advised against fasting
l Pregnant women with hyperglycaemia
l History of recurrent episodes of hypoglycaemia
l Lack of understanding of hypo/hyperglycaemia
l History of poor diabetes control and/or non-compliance with medical treatment
l Patients ‘unwilling’ or ‘unable’ to monitor and manage their blood glucose levels
(The doctor is a founder of Dr A Ramachandran’s Diabetes Hospitals, Chennai and president of India Diabetes Research Foundation (IDRF)