Diabetes and Ramadan
Fasting is one of the five pillars of Islam. Muslims fast as a mean to be closer to God through steady remembrance, reflection and sacrifice. However, long hours of fasting can cause additional health problems especially if you have diabetes.
With Ramadan approaching, Muslims with diabetes are advised to take extra precautions to prevent risks and complications, which can lead to seizures, coma and even death if left untreated.
Here are some commonly asked questions and guides on how to fast safely during Ramadan.
COMMONLY ASKED QUESTIONS
Q1: I am diabetic. Can I fast?
Choosing to fast is a personal decision, and individuals with a certain health condition are exempted from fasting – including those with diabetes. The table below shows the different risk categories of the patient with diabetes. Those categorised in the very high and high-risk group is advised to abstain from fasting.
– History of severe diabetes complications within 3 months prior to fasting:
- Severe hypoglycaemia
- Diabetic ketoacidosis
- Hyperglycaemic hyperosmolar state
- Recurrent hypoglycaemia
– Hypoglycaemia unawareness
– Type 1 diabetes
– Acute severe illness
– Sustained poor glycaemic control (A1c >9%)
– Performing intense physical labour
– Advanced renal failure/chronic haemodialysis
– Moderate hyperglycaemia (A1c 7.5–9.0%)
– Moderate renal failure
– Advanced macrovascular complications
– Living alone and treated with insulin or sulphonylureas (Gliclazide, Glimepiride or Glipizide)
– Patients with comorbid conditions that present additional risk factors
– Old age with ill health
– Treatment with drugs that may affect mentation
Well-controlled diabetes treated with short-acting insulin secretagogues (Aspart).
Well-controlled diabetes treated with lifestyle therapy, metformin, acarbose, incretin-based therapies (Byduron) and/or SGLT2 inhibitors (Glifozin) in otherwise healthy patients.
If you choose to fast, preparation is very important especially if you are taking any medications and/ or insulin for your blood glucose control.
Question 2: Should I continue taking my medications?
Yes, it is very important that you continue to take your medications in Ramadan. However, some medications may give you low blood sugar levels (hypoglycemia). When you don’t eat and take these types of medications, you may be at greater risk of low blood sugar levels. If you do not take your medications, due to the change of the type of foods eaten in Ramadan and timings of meals, you may be at risk of high blood sugar levels.
The dose and timings of your medications may need to be changed, hence speak to your doctor before Ramadan.
Question 3: Do I skip my insulin when fasting?
You are still required to take your insulin injections however individualised adjustments of insulin dose and timing will need to be implemented when fasting during Ramadan. Speak to your doctor for the changes.
Question 4: Will testing my blood glucose break my fast?
No as it does not involve taking food or drink. In fact, you are advised to check your blood glucose regularly during fasting. It is important to test your blood glucose levels more often as they may drop too low (hypoglycaemia) particularly if you are unwell and/or treated with insulin or taking a sulphonyurea e.g. Gliclazide, Glimepiride or Glipizide you are at risk of hypoglycaemia as you are missing a meal.
Question 5: What dietary changes should i take note of?
There are some key changes in your dietary habits that you should take note.
- You must eat a balanced meal at Sahur with adequate carbohydrate taken as late as possible just before Imsak (dawn) to avoid unnecessarily prolonged fasting.
- Do not delay the breaking of fast at sunset (Iftar) but limit intake of high-sugar foods. However, 1–2 kurma at the start of Iftar following the practice of the Prophet (Sunnah) may be taken as part of your carbohydrate exchange. The main meal is encouraged after the performance of Maghrib prayers.
- Limit intake of salty foods to prevent dehydration.
- Ensure adequate fluid is taken to replenish fluid loss during the day. Aim for 8 glasses of plain water a day.
Question 6: What do I do if my blood glucose level is low?
Know the early signs and symptoms of hypoglycaemia. Early signs may be shaking, sweating, hunger, palpitations. If you experience any of the symptoms you must stop what you are doing and check your blood glucose level. If your blood glucose is less than 4mmol/l, you must break your fast.
Treat the low blood glucose immediately with one of the following:
- A glass of pure fruit juice, 150 – 200ml
- A tablespoon of honey
- A tablespoon of sugar
Check your blood glucose after 10 – 15 minutes and if it is still less than 4.0mmol/l, repeat the treatment as above. After you have treated the low blood sugar level, you must have a snack or usual meal that due at that time of the day.
Your family must know what signs to look out for if you get hypoglycemia and be able to treat you.
You should also break your fast if your glucose reading is >16.7 mmol/L.
Speak to your doctor and mufti on areas of your concern. Fasting during Ramadan can be safely done with good preparation and with the right knowledge.
Clinical Practice Guidelines (CPG) on Management of Type 2 Diabetes Mellitus (5th ed.)