HYDERABAD: Every year during the holy month of Ramadan, India’s 180 million Muslim population gears up to fast every day without food, water or medication for close to 15 hours, from well before dawn till just after sundown. Such a fast, as we know, can have a number of positive outcomes such as weight reduction and improvement in lipid levels.
However, for people with diabetes, fasting for thirty days or sometimes even for one day can be quite risky. It can lead to several complications such as fluctuating blood sugar levels with blood glucose rising or falling, hypoglycaemia, dehydration and even blood clots. This is why it is absolutely necessary to consult a doctor before starting the Ramadan fast if you are a diabetes patient or if someone in your family has diabetes. The doctor can help you control and manage these complications and must be consulted regularly all through the one-month period. Equally important is the daily monitoring of health at home, specifically regular blood sugar testing through the day.
First things first
Follow the medical advice given to you rigorously without compromising on diet recommendations and medication schedules. All patients should comprehend the dangers of low and high blood glucose levels and know to break the fast if blood glucose is 300 mg/dL. Patients are advised to monitor their blood glucose several times during the day while fasting and track symptoms of hypoglycaemia. The regularity of the blood glucose checks is dependent on the frequency of insulin treatment and/or the risk of hypo- or hyperglycaemia, so it is important to discuss this with your doctor.
SGLT2 inhibitors and GLP 1 receptor agonists are comparatively newer drugs that have been approved in management of type 2 diabetes – please speak to your doctor regarding these choices for management of diabetes during Ramadan.
Patients also need to follow a daily meal plan, that ensures good control over blood sugar levels. During the sehri and iftar, diabetes patients need to consume complex carbohydrates and low glycemic food like unrefined rice, whole grain, dal, fruit and vegetables. About 20%-30% of the meal should comprise some protein which can be obtained by including lentils, beans and pulses in the diet. These substances are also low in fat. Lean meats are also a good option as they keep saturated fat under control. Recommended cooking methods are grilling and baking, with very little salt or sweeteners added. When breaking the fast, patients should begin with consuming small portions so that the system does not get over loaded and avoid sweet, fried or fatty food.
The biggest challenge for diabetes patients during the Ramadan fast is overcome or manage dehydration. Even without fasting diabetic patients are usually required to maintain a high-level of fluid intake. During the fast they go without any fluid intake for over 12-16 hours. The most appropriate advice here is to avoid beverages with a high sugar level and caffeine at both Sehri and Iftar because these can induce more dehydration.
Although for high-risk diabetes patients, it is advisable to avoid fasting, but the tradition can still be continued with a few changes in their medication and diet. Doctors and patients must work in collaboration to adjust these schedules to manage diabetes effectively by using therapies and the right medicines, which can maintain good blood sugar control and curb the risk of blood sugar levels changing drastically.
The author is the founder of Dr Ishaq‘s Diabetes Centre Hyderabad