Break the fast if you have hypoglycemic symptoms, experts advise diabetic patients

Islamabad

Fasting is generally very challenging for people living with diabetes, particularly insulin-dependent patients with Type 1 diabetes. Diabetic patients who wish to fast must diligently plan for a safe Ramazan. It is important to individualize each patient’s management plan, depending on their diet and lifestyle, medications, risk of hypoglycemia, and glycemic control, and to minimize complications associated with fasting. Generally, the risk of hypoglycemia and hyperglycemia in patients with Type 2 diabetes is not overly common, and has less severe consequences.

Consultant endocrinologist at Shifa International Hospital (SIH) Dr. Sheraz Khan shared this information at a seminar on ‘Roza aur Sehat,’ organized to create awareness in diabetic patients who intend to fast without harming their
blood glucose level. A large number of patients, doctors and people from various walks of life attended the seminar.

The approximate number of Muslims with diabetes is around 4.6%; an estimated 50 million Muslims with diabetes around the world observe fasting during the month of Ramazan each year, Dr. Sheraz shared. Islam exempts people from the duty of fasting if they are sick, or if fasting affects their health, as fasting for patients with diabetes carries a risk of an assortment of complications including hypoglycemia, postprandial hyperglycemia, and metabolic complications associated with dehydration.

Nevertheless, a large number of people with diabetes still choose to fast during Ramazan despite the advice of their doctor and permission from religious authorities, thus creating medical challenges for themselves and their healthcare providers. It is thus important for such patients to make necessary preparations to engage in fasting as safely as possible, Dr. Sheraz underlined.

Consultant endocrinologist at SIH Dr. Tayyab Badshah said, patients may be reluctant to self-monitor during Ramazan. 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.

“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,” Dr. Tayyab advised.

Clinical dietitian at SIH Zainab Ghayyor advised 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 in recommended dosage and timings. If you experience hypoglycemic symptoms, it is advisable to break the fast and make up for it after Ramazan,” Dr. Zainad also suggested.

Dr. Zainab said, the ‘sehri’ 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, and small amounts of heart healthy fats. Also include fresh fruits, vegetables, and yoghurt in your meals.

“Limit the dates 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 at SIH Azmatullah Quraishi highlighted the importance of fasting for spiritual cleaning of the soul. He said, there is 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 are exempted. He added that
the use of injections (except nutritional injection),
asthmatic inhalers, along with blood donation, vomiting, and pouring medicines into the eyes or ears are practices that do not affect the fast.

“Pregnant Muslim women or feeding mothers are exempt from fasting during Ramazan; however, they are required to feed a needy person or fast in later days,” he concluded.