Diabetes is a common problem in our milieu with variable figures but in general one in 10 persons in Kashmir has diabetes needing medicines.
In the holy month of Ramadan, Muslims worldwide observe a daily fast from sunrise to sunset. Ramadan fasting is a type of intermittent fasting. Intermittent fasting is an eating pattern where you cycle between periods of eating and fasting; and it is increasing in popularity as a means of losing weight and controlling chronic illnesses.
Although the evidence is not robust, studies have shown that intermittent fasting in people with diabetes may help reduce body weight, improve glycemia (HbA1c), improve insulin sensitivity, improve LDL and HDL cholesterol, improve other cardiovascular disease markers, and reduce central adiposity.
Ramadan fasting in diabetic patients may have similar benefits. In addition, it may have a positive effect on increased self-esteem, reduce anxiety and stress, and may help with self-control.
Pre-Ramadan education and counselling is important for diabetic patients planning to fast during Ramadan. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity, medication and its dose adjustment, side effects, recognizing hypoglycemia including its corrective measures, and knowing when to break the fast.
Although fasting by itself has many benefits, diabetic patients are at a high risk for development of a wide range of potential fasting related complications such as dehydration, hypoglycemia, hyperglycemia, and diabetic ketoacidosis (DKA).
For a diabetic patient, understanding the risk of fasting will depend upon various factors like the type of diabetes, duration of diabetes, recent sugar control, recent hypoglycemic (very low sugar levels) episodes of hypoglycemia unawareness, presence of diabetes complications like cardiovascular disease (history of heart attacks or having a previous stenting or bypass surgery etc.), chronic kidney disease, retinopathy, and the type of anti-diabetes medication used.
Depending upon these factors, Ramadan fasting can be associated with very high/ high risk and is thus not advisable for the following patients with type 2 diabetes:
} Severe hypoglycemia (low blood glucose <55 mg/dl, along with loss of consciousness) within 3 months prior to Ramadan
} Severe hyperglycemia with average blood glucose >300 mg/dl, or HbA1c >10%
} A history of recurrent hypoglycemia or hypoglycemia unawareness
} Diabetic ketoacidosis/ hyperosmolar hyperglycemic state within 3 months prior to Ramadan
} Any acute illness
} Those performing intense physical activity
} Those on dialysis
} Patients with significant dementia or cognitive defects
} Presence of significant microvascular/ macrovascular complications of diabetes like heart disease, kidney disease, or retinopathy or neuropathy
} Elderly living alone and treated with insulin or sulfonylureas.
Apart from these, fasting is also not advised for patients with type 1 diabetes (diabetes from childhood, no insulin production from pancreas) of any age because of the high risk of hypoglycemia associated with fasting.
In general the morning medication should be taken at Sahiri with plenty of fluids (water, tea, lemon water etc.). During the day avoid exposing yourself to direct sunlight. Evening medicines with Iftiyari and after Taravih namaz. Insulin users’ same pattern but no additional insulin during the day. Post dinner insulin in the initial days after checking sugar levels.
Take Home Message:
Although Ramadan fasting may be beneficial for some patients with diabetes, even then, these patients should meet their physicians prior to Ramadan, to get education to learn about better management of their diabetes during fasting and modification of their anti-diabetes.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK