DIABETES AND RAMADAN FASTING

Fasting during Ramadan, one of the five pillars of Islam, is an obligatory duty for all healthy adult Muslims. Ramadan, a lunar month, can last for 29 or 30 days, and its timing changes with respect to seasons. Depending on the geographical location and season, the duration of the daily fast may range from a few to 20 hours. Muslims who fast during Ramadan must abstain from eating, drinking, taking oral medications, and smoking from before dawn until after sunset; there are no restrictions on food or fluid intake between sunset and dawn. The Qur’an specifically exempts people with a medical condition from the duty of fasting.
Complications of fasting include dangerously low blood glucose (hypoglycaemia), excessively high blood glucose (hyperglycaemia), diabetic ketoacidosis, and dehydration & thrombosis.
General Considerations
It is mandatory that people have the means to monitor their blood glucose levels several times throughout the day, every day. This is especially critical in people who require insulin.
Nutrition
People should maintain a healthy and balanced diet during Ramadan. The common practice of ingesting large amounts of foods that are high in fat and carbohydrates, especially at the sunset meal, should be avoided. It is recommended that non-caloric fluid intake be increased during the non-fasting hours. The pre-dawn meal should be taken as late as possible before the start of the daily fast. Compensatory eating should be avoided when one opens their fasts. Diets should remain the same during fasting periods.
Physical activity
Normal levels of physical activity can be maintained. However, excessive physical activity may lead to higher risk of hypoglycaemia and should be avoided. If Tarawih prayers (multiple prayers after the sunset meal) are performed, they should be considered a part of a person’s daily physical activity programme.


Breakng the fast
It is essential that people with diabetes understand that they must end their fast immediately in the following cases: if blood glucose levels drop dramatically – 3.3 mmol/l (0 mg/dl) or lower if blood glucose reaches 3.9 mmol/l (70 mg/dl) in the first few hours after the start of the fast, especially if insulin, sulfonylureas, or meglitinides are taken at the pre-dawn meal & if blood glucose levels rise excessively 1.5 mmol/l (300 mg/dl).
People with type 1 diabetes
In general, people with type 1 diabetes are at very high risk of developing severe complications, and should be strongly advised to not fast during Ramadan.
People with type 2 diabetes - Lifestyle and nutrition
In people with type 2 diabetes who manage their diabetes with diet and physical activity, the risks associated with fasting are quite low. However, if people eat excessively, there remains a potential risk of post-meal hyperglycaemia after the pre-dawn and sunset meals. Distributing energy intake over two to three smaller meals during the non-fasting interval may help to prevent excessive post-meal hyperglycaemia. A person’s regular daily exercise programme should be modified in its intensity and timing to avoid episodes of hypoglycaemia.
Oral medications In general, medications that act by increasing insulin sensitivity are associated with a significantly lower risk of hypoglycaemia than compounds that act by increasing insulin secretion. People who take metformin may fast safely because the possibility of hypoglycemia is minimal. However, the timing of the doses should be modified: two thirds of the total daily dose to be taken immediately before the sunset meal, with the other third taken before the pre-dawn meal.
People on insulin sensitizers (rosiglitazone and pioglitazone) have a low risk of hypoglycemia. Usually no change in dose is required.
Sulfonylureas are believed to be unsuitable for use during fasting because of the inherent risk of hypoglycemia; they should be used with caution. Chlorpropamide is absolutely not recommended during Ramadan because of the high possibility of prolonged and unpredictable hypoglycemia.
Insulin
The problems facing people with type 2 diabetes who take insulin are similar to those associated with type 1 diabetes, although the incidence of hypoglycaemia is lower. Again, the aim should be to maintain necessary levels of basal insulin. A key objective is to suppress output of glucose from the liver to near-normal levels during fasting. Careful use of intermediate or long-acting insulins plus a short-acting insulin administered before meals would be an effective strategy.


NOTE!
In persons with underlying complications, such as cardiac failure, nephropathy and hypoglycaemic unawareness, fasting should be discouraged.
-People who fast should have ready access to their health-care providers during the period of fast.
-A total fast is not recommended for anyone with diabetes. Adequate hydration is important even during the period of fasting.
- The Holy Qur’an explicitly forbids acts that are harmful and injurious to one's own self, and persons with diabetes would be putting their health, safety and even life itself in jeopardy if they go against medical advice.
The decision to fast should be taken by three people: The person with diabetes, his or her healthcare provider and a religious advisor. It is of the utmost importance that people with diabetes and their healthcare providers are aware of the potential risks associated with fasting.
To all our Muslim Brothers, may Allah accept all your Prayers in this Ramadan. ♡♥