Fasting among diabetic patients during Ramadan

What you should know!

There is a strong inclination on the part of Muslims who are diabetics to fast during the holy month of Ramadan. It is important that they visit their doctor at least 3-4 weeks before the fasting month of Ramdan for assessment of their diabetes control and also counselling. During these visits, their blood sugars, and medications are checked to ascertain which risk category they are for fasting - high risk, moderate risk or low risk. Accordingly, they receive advice on medications and nutrition.

Who are the risk group?

High risk patients are those whose blood sugars are high and not controlled, and also have other problems with heart and kidney. They should avoid fasting. Moderate risk are reasonably well controlled but should fast with precautions. Low risk is those with mild diabetes and well controlled sugars. They can fast without any problem.

What complications can occur during fasting in patients without proper control?

The complications that can occasionally occur during fasting in diabetic patients are as follows:

1. Hypoglycemia- low blood glucose levels causing sweating, palpitations, drowsiness, and convulsions if not corrected.

2. Hyperglycemia- high blood glucose levels due to inadequate medications and control.

3. Dehydration and electrolyte imbalance- especially in elderly and in hot summer months.

4. Thrombosis- clot formation and risk of stroke.

These complications are not often seen in clinical practice if adequate precautions and advice from doctors is followed. The blood glucose can be monitored in patients at risk using a glucometer to prevent hypoglycemia or hyperglycemia. There is an agreement that pin- prick for sugar measurements does not lead to breaking of fast.

When to break a fast?

You should break the fast and seek medical attention in following conditions.

*If a diabetic patient who is fasting develops symptoms of hypoglycemia or on glucometer it shows blood glucose of less than 70mg%.

* If blood glucose on glucometer is more than 300mg% and patient has nausea, vomiting or urine tests positive for ketones, especially in Type 1 diabetic patients.

What nutritional advice to be given?

At pre-dawn meals (Sehri) it is better to consume foods which release glucose slowly like complex carbohydrates- whole grains, whole bread. We can advise beans, pulses, and lentil. It is better to avoid fatty foods- like poori or aloo parota.

At Iftar, avoid concentrated sugars like sweets, and sweetened beverages. Avoid oily foods. Fruits and leafy vegetables can be consumed. Increase fluid intake during non-fasting hours to prevent dehydration.

Medication counselling:

The doctor would advise some adjustment of medications, and their dosages to make it safer for you to fast in the month of Ramdan. With due precautions and care and with doctor’s advice, most diabetic patients can fast safely in the month of Ramdan.

(The writer is a Senior consultant Physician, Apollo Hospitals)