This time, the holy month of Ramzan falls not just during summer, but also at a time when the entire world is battling the novel Coronavirus pandemic. It is pertinent in this context that all those observing Ramzan need to follow stringent measures for their own safety, that of their loved ones and the society. Diabetics, especially those with poor control are at increased risk of contracting infections, and this applies to Covid-19 as well. The complications and death rates due to the disease are high in those with diabetes than non-diabetics, especially if glucose control is not good. Staying at home, maintaining social distance and wearing masks is a must, as is avoiding Eid shopping by physically going out.
Iftar parties can be celebrated at home with family, but it is essential to avoid going out or celebrating with others. The same health principles apply to religious prayers and whilst doing charity work as well. Instead of physically risking exposure to infection while doing charity work, one may use digital transfers to poor relatives, friends, neighbours, orphanages and NGOs. Washing hands thoroughly and frequently, at least 20 seconds each time with soap and water, is another key measure to protect against the virus. Before deciding to fast during Ramzan, it is essential for all diabetics to check with a specialist if it is safe to fast or not. Those with poorly controlled glucose, those at increased risk of low blood glucose, kidney, liver and heart diseases are usually advised not to fast.
Pregnant women with diabetes are also advised not to fast. Prepare at least a few weeks ahead of Ramzan by consulting a doctor, doing the HbA1c test which tells you your average level of blood sugar over the past two to three months, and adjusting medicines if required. Telemedicine consultations can be of paramount help in times like this and they can limit physical visits to hospitals. Fasting can predispose individuals to risk of low blood glucose and feasting after the fast can lead to surges in blood glucose levels. Continuous glucose monitoring systems can be used to track blood glucose at the convenience of one’s home or work place. If one is fasting, it is important to be aware of the symptoms and signs of low blood glucose and check blood glucose levels using a glucometer.
Usually, medications such as Metformin, Pioglitazone, DPP4 inhibitors, Alpha Glucosidase inhibitors, some GLP1 receptor agonists and selective Sulphonylureas are considered safer in terms of lower tendency than others to cause low blood glucose. Pills such as certain Sulfonylureas and certain Insulin types have a higher tendency to cause low blood glucose and may need changing to better options during Ramzan fasting month. Insulin type and doses may need changing to avoid low blood glucose and also facilitate better glucose control.
A particular class of diabetes medicine called SGLT2 inhibitors have a lower risk of low blood glucose but carries a risk of causing dehydration and increasing acid content in blood and hence best avoided in those who fast. Medicines have to be strictly individualised as per medical advice only. It is advised to avoid fatty foods, fruit juices and excessquantity of fruits like mangos or too many dates. Brown rice, millets, whole grain atta to make rotis, low fat milk are healthier options. Chicken and fish are fine as long as not fried and it is recommended to avoid red meat in view of its long term deleterious effects on health. It is also essential to have a schedule to the day and sleep on time. By following precautions, those with diabetes can have a safe Ramzan.
Dr Ravi Sankar Erukulapati Senior Consultant Endocrinologist Apollo Hospitals, Jubilee Hills