Ramadan Fasting and Diabetes
Ramadan, the ninth month of Islamic lunar calendar, is marked by religious ritual of fasting from early dawn till sunset by Muslims. Islam has allowed many categories of people to be exempt totally or temporarily from fasting.
Fasting during Ramadan potentially affects dietary habits, daily physical activity, sleeping patterns, glycemic control, weight, lipid profile and food intake.
WHAT HAPPENS TO MY BODY WHEN I FAST?
When we don’t eat during a fast at about eight hours, after our last meal, our bodies start to use energy stores to keep our blood glucose (sugar) levels normal. For most people, this is not harmful. With diabetes, especially if you take certain tablets or insulin, you are at risk of hypoglycemia (low blood glucose levels). Another problem that can occur if you have diabetes, is the risk of high glucose levels following the larger meals that we eat before and after fasting (at Suhoor/Sehri and Iftar). Hypo and hyper glycemia both are dangerous for people with diabetes.
I HAVE DIABETES – CAN I FAST?
A person with diabetes has every right to perform his ritual fasting. But when he or she intends to performs fasting in Ramadan, they should plan at least few months before, so that certain factors can be assessed by the Endocrinologist:
- Assessment of glycemic status – Avoid fasting if HbA 1c is more than >10%, or in the presence of frequent hypoglycemia, hypoglycemic unawareness, high fluctuation of blood glucose profile.
- Assessment of complications and other co morbid conditions which may be aggravated by prolonged fasting.
- Change in diet and meal plan according to customs of Ramadan and maintaining same calorie intake.
- Possibility of dehydration and electrolyte imbalance should be looked for.
WHAT TYPES OF FOOD SHOULD I EAT AT SUHOOR (SEHRI)?
Suhoor needs to be wholesome to provide enough energy to last during the long hours of fasting. At Suhoor you should eat carbohydrates which release energy slowly with protein and fiber such as:
- Multigrain bread sandwich (stuffed with veggies and paneer) + fruit + coconut water
- Oat – based cereals + mixed fruit bowl and Papaya smoothie
- Brown rice pulav with vegetables and nutrela
- Fruit yoghurt + toast and boiled egg white
- Vegetable and Chicken roll with milk and fruit
- Haleem with a katori of de-starched rice
Eat sensibly, do not overeat & remember to drink plenty of liquids.
WHAT TYPES OF FOOD SHOULD I EAT AT IFTAR?
Iftar is the time you replenish energy levels, so try to add foods from all the major food groups.
Traditionally during Ramadan, dates are eaten at the start of Iftar to symbolize the breaking of the fast. Besides being an excellent source of dietary fiber and potassium, the dates are also high in sugar so watch your portion on it. Whole wheat bread takes longer to digest, helping to sustain energy levels longer. Incorporate protein rich sources such as lean meat, skinless chicken, fish, eggs, legumes and low-fat dairy products. Ensure 2 serving of vegetables and 1 serving of fruit. To keep your meals healthy, limit the use of oil and opt for steam cooking, grilling, baking or shallow frying instead of deep frying. When choosing oils, you should pick those that are high in unsaturated fats such as Canola, soybean, rice bran, mustard oil. Keep portion size in control. Remember that Ramadan is also about self control and discipline.
WHAT TYPES OF DRINKS CAN I HAVE?
Fasting can put you at risk of dehydration, with long hours of fasting and also if you have high blood glucose levels. Drink plenty of fluids like coconut water/lemon water/herbal tea/milk smoothies/butter milk, vegetables or chicken broth at Suhoor and after Iftar.
WHAT KIND OF EXERCISE I CAN DO?
Normal level of physical activity should be maintained. Rigorous exercise during fasting hours should be avoided.
Sugar Monitoring, Medicines & Insulin Dose Adjustments
Blood glucose levels should be monitored during fasting to recognize hypo and hyper glycemia. If sugars are less than <70 mg/dl, immediately break the fast and treat with rapid acting carbohydrates like glucose.
You can monitor sugar levels 2 hours post Suhoor and half hour before Iftar.
Change of insulin regime should be customized and individualized according to food habit, food composition adopted specially during the fasting state and also the previous insulin regime, the patient was using prior to the Ramadan month.
If on Basal and Bolus insulin therapy (4 insulin shots per day)
Bolus portion (short acting insulin)
Morning dose: Take your morning dose at the time of Sehri
Lunch dose: Skip the lunch dose as not taking any meal
Evening dose: Take this at the time of Iftar
Basal dose: Half dose along with Iftar
Pre mix insulin (like mixtard 30/70, Novomix 30, Huminsulin 30/70
It is recommended to avoid pre mixed insulin during fasting. If you still want to continue the same, then reduce the morning dose by 30% & evening dose remains the same.
Adjustment in Medication:
- Twice-daily sulfonylureas like (Amaryl, Daonil, Glimy) the usual dose should be reduced to half of the dose at the sunset meal (Iftar) and two third at the pre-dawn meal (Sehri).
- Who are on Metformin continue the same.
- No adjustments are needed for thiazolidinediones (Actos, Avandia) alpha-glucosidase inhibitors (glucobay, glyset) incretin-based therapies (Januvia, onglyza, trajenta) unless they are in the combination with sulfonylureas.
- Always carry glucose tablet/powder with you.
- Always have diabetes identification, such as a card or a medical bracelet.
- Test your blood glucose level if you feel during the fast.
- If you become dehydrated, end the fast immediately and have a drink of water.
- You should never stop your insulin, but you must speak to your doctor because you may need to change the dose and times of your insulin injection.
Clinical Nutritionist & Diabetes Educator
Cure & Curves Diet Clinic, Shalimar Bagh