Break the fast if you experience hypoglycemic symptoms

Islamabad: Fasting is very challenging for people living with diabetes, particularly insulin-dependent patients with type 1 diabetes. Muslims with diabetes who wish to fast must plan diligently for a safe Ramazan. It is important to individualize each patient’s management plan depending on his or her diet and lifestyle, medications, risk of hypoglycemia, and glycemic control, and to minimize the complications associated with fasting.

Consultant endocrinologist at Shifa International Hospital (SIH) Dr. Osama Ishtiaq shared this piece of advice at a seminar on ‘Roza aur Sehat’ organised here Thursday to create awareness in diabetic patients who intend to observe fasting without harming their blood glucose level. A large number of patients, doctors and people from various walks of life attended the seminar.

Dr. Osama informed that in general, the risk of hypoglycemia and hyperglycemia in patients with type 2 diabetes is not overly common, and it is associated less severe consequences. Yet, it is critically important for patients who wish to fast during Ramazan to make necessary preparations to engage in fasting as safely as possible. Fasting for patients with diabetes carries the risk of an assortment of complications including hypoglycemia, postprandial hyperglycemia, and metabolic complications associated with dehydration.

Dr. Osama added that 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 Ramazan. 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 Ramazan bringing HbA1c to < 8 and continue diabetic diet at ‘iftaar’ and ‘sehri’,” Dr. Osama advised.

Senior clinical dietitian Zainab Ghayyor termed overeating as the greatest risk and advised patients to keep the portion sizes moderate and to watch out for eating too many sweets. “Continue taking your diabetes medicine but if you experience hypoglycemic symptoms, it is advisable to break the fast and make up for it after Ramazan,” she advised. She 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. Limit dates (khajoor) to two or three pieces. Limit physical activity during fasting hours and be more active after sunset,” she suggested.

Azmatullah Quraishi, Head of Religious Affairs, highlighted the importance of fasting in Islam. He said there is no excuse for skipping fasting in minor diseases like flu or fever. However those who are ill with no expectation of recovery, and those who are too old and unable to fast are exempted. “Pregnant Muslim women or feeding mothers are exempted from fasting during Ramazan; however, they are required to feed a needy person (two meals - as fidya or compensation for one fast), or fast in later days,” he added.

Islam exempts people from fasting if they are sick or if fasting can affect their health. Nevertheless, many people with diabetes still choose to fast during Ramazan against the advice of their doctors, as they perceive themselves healthy and able to fast. An estimated 50 million Muslims with diabetes around the world observe fasting during the month of Ramazan each year.