Islamabad, May 20, 2017 (PPI-OT): In general, fasting is very challenging for people living with diabetes, particularly patients with type 1 diabetes, who are dependent on insulin. Muslims with diabetes who wish to fast must plan diligently for a safe and healthy Ramadan. It is important to individualize each patient’s management plan depending on his or her diet and lifestyle, medications, risk of hypoglycaemia, and glycemic control, and to minimize the complications associated with fasting.
In general, the risk of hypoglycaemia and hyperglycaemia in patients with type 2 diabetes is not overly common, and it is associated less severe consequences, said Consultant Endocrinologist, Shifa International Hospital (SIH) Dr. Sheraz Khan in a seminar “Roza aur Sehat” organized by Shifa International Hospital to create awareness in diabetic patients intended to observe fasting without harming their blood glucose level.
A large number of patients, doctors and people from all walks of life attended the seminar. It is important to note that SIH as its social responsibility organized this event every year before Ramadan to educate people about their health problems and its solution regarding fasting.
Dr. Sheraz said that the approximate number of Muslims with diabetes is around 4.6%; it is estimated that there are about 50 million Muslims with diabetes around the world who observe fasting during the month of Ramadan each year. During the fast, Muslims are required to refrain from eating food, drinking, using medications, and smoking from dawn until sunset, with no restrictions on food or fluid intake between sunset and dawn.
Islam exempts people from the duty of fasting if they are sick, or if fasting may affect their health, as fasting for patients with diabetes carries a risk of an assortment of complications, including hypoglycaemia, postprandial hyperglycaemia, and metabolic complications, associated with dehydration.
Nevertheless, a large number of people with diabetes who still choose to fast during Ramadan despite the advice of their doctor, and the permission received from religious authorities thus create medical challenges for themselves and their health-care providers. It is thus important for patients with diabetes who wish to fast during Ramadan to make the necessary preparations to engage in fasting as safely as possible, he underlined.
Consultant Endocrinologist, Shifa International Hospital (SIH) Dr. Tayyab Badshah said that patients may be reluctant to self-monitor during Ramadan. Clinical experience suggests some patients may cease treatment altogether in order to observe the fast or because they feel changing time of treatment may render it ineffective. Unwillingness to self-treat hypoglycaemia symptoms by breaking the fast may lead to more severe hypoglycaemia. This represents a key challenge for patients with diabetes during Ramadan.
He added that the Testing your blood glucose levels is important and it does not break the fast. If you have a blood testing meter, test your glucose levels regularly. Talk to your doctor or diabetes team before fasting. Look for signs of hyperglycaemia, hypoglycaemia and dehydration. Make sure someone you know is aware that you are fasting. Always carry your glucose tablets, glucose gel or a sugary drink in case of a hypo. This may need to be followed up with a snack like a piece of fruit, biscuit or half a sandwich. Finally, if you are ill it is important that you break your fast.
Patient should monitor blood glucose regularly during the fast, especially in the early days. Continue taking your diabetes medicine as per advice of your doctor regarding dosage and timings. “Control your Diabetes for two months prior to Ramadan bringing HbA1c to (less than) 8 and continue Diabetic diet in Iftaar and Sahur,” Dr. Tayyab advised.
Clinical Dietician, Shifa International Hospital (SIH) Zainab Ghayyor advised the patients to monitor their blood glucose regularly during the fast, especially in the early days. Watch out for eating too many sweets and keep the portion sizes moderate. Overeating is a greatest risk. Continue taking your diabetes medicine, regarding dosage and timings talk to your doctor. If you experience hypoglycaemic symptoms, it is advisable to break the fast and make up for it after Ramadan.
She said that suhoor meal should contain a balance of whole grain sources of complex carbohydrates as well as some protein from lean sources of meat, fish and poultry, small amounts of heart healthy fats, limit added sugars this will slow the digestion and the feeling of fullness last as long as possible into the day. Also include fresh fruits, vegetables, and yoghurt in your meals. Limit the dates (Khajoor) to two or three pieces. Avoid exercise during the day, and take rest when possible to help avoid lowering of blood glucose levels. Limit physical activity during fasting hours and be more active after sunset,” she suggested.
Head of Religious Affairs, Shifa International Hospital (SIH) Azmatullah Qureshi while highlighting the importance of fasting in Islam and its positive and spiritual impacts, said that Islam exempts people from the duty of fasting if they are sick or if fasting may affect their health. Nevertheless, many people with diabetes still choose to fast during Ramadan against the advice of their doctors, as they perceive themselves as healthy and able to fast.
He said that there was no excuse for skipping fasting in minor diseases like flu or fever. Those who are ill with no expectation of recovery, and those who are too old and are not able to fast. Some health practices that do not affect fast such as use of injection (except nutritional injection), using asthmatic inhaler and donating blood, vomiting, and pouring medicines into the eyes or ears.
Pregnant Muslim women or feeding mothers are exempt from fasting during Ramadan; however, they are required to feed a needy person on which they do not fast (two meals – as Fidya or compensation for one fast), or fast in later days, he stated.
For more information, contact:
Shifa International Hospitals Limited
Pitras Bukhari Road H-8/4,
Islamabad – Pakistan