Although Ramadan is over, there are valuable points for people with diabetes to remember when carrying out their yearly fasting duty
BY PROF DR NORLAILA MUSTAFA
FASTING during Ramadan is one of the five main pillars of being a Muslim. Most Muslims are passionate about fasting during this month.
There are about 1.9 billion Muslims globally, and the number keeps increasing by about three per cent yearly. In Malaysia, about 62 per cent of the population are Muslims.
Although the Quran exempts sick people from the duty of fasting, many Muslims with diabetes are keen to fast. It is important for people with diabetes to discuss with their doctors before deciding to fast.
This includes understanding their diabetes control, the risk of fasting to their health, how to reduce this risk and whether the risk is too high to perform the Ramadan fasting. If someone cannot perform the Ramadan fasting for health reasons, they should discuss with the Imam and ask for advice about an alternative to fasting.
The average of Ramadan fasting in Malaysia is about 14 hours, which means abstaining from eating and drinking from after Suhor (sunrise) until Iftar (breaking the fast at sunset). People with diabetes are encouraged to drink a lot of water after breaking their fast to prevent dehydration.
Decreased food intake is a well-known risk factor for developing hypoglycaemia (low blood sugar, <4.0 mmol/L) especially when there is no proper adjustment with anti-diabetic medications, both oral and injectable. Other known risks associated with fasting among people with diabetes are hyperglycaemia (high blood sugar) and thrombosis (occlusion of the vessels due to the formation of blood clots).
Population-based studies (EPIDIAR Study) have shown that both risks of hypo and hyperglycaemia are high during fasting Ramadan in people with diabetes. This is true if the diabetes is not well controlled. Proper education about fasting is not given to them.
Monitoring blood sugar levels is important
Symptoms of low blood sugar or hypoglycaemia are lightheadedness, sweating, feeling tired, feeling hungry, tingling lips, feeling shaky or trembling and a fast or pounding heartbeat (palpitations). In severe cases, hypoglycaemia can also cause seizure, loss of consciousness and lead to coma.
Hyperglycaemia during Ramadan fasting can be due to excessive reduction of medication dosages to prevent hypoglycaemia. An increase in food or sugar intake during non-fasting hours (after Iftar until Suhor) also had significantly higher severe hyperglycemia rates. Therefore, patients with diabetes who want to observe Ramadan fasting must be adequately educated by their doctor on the medication dosage adjustment and blood sugar monitoring. Symptoms of hyperglycaemia include being extremely tired, thirsty, passing a lot of urine, blurred vision, dryness of mouth and skin and headache. Severe hyperglycaemia will also lead to dehydration and can cause acute kidney failure.
People with diabetes tend to take the importance of monitoring blood sugar for granted and only do so once they have symptoms of hypo or hyperglycemia. The blood sugar monitoring should be done as often as possible during fasting and be sure to have the monitoring strips available at all times.
If the blood sugar drops below 4.0 mmol/L and yet there are no symptoms of hypoglycaemia, you must break your fast. Failing to do so will be detrimental to your health as the blood sugar can drop further and lead to a coma.
Hypoglycaemia occurs quite often, as people with diabetes will still take diabetic medications. Similarly, if your blood glucose is high and you have symptoms of hyperglycaemia as mentioned above, you must break your fast too.
Watch your salt intake too
It is important not to skip the Suhor meal, just before dawn. You are encouraged to drink a lot of water to prevent the risk of dehydration. Healthy eating such as taking high fibre foods like cereal, oats, or brown rice is more slowly absorbed and has a low glycemic index.
This will help maintain your blood sugar within a normal range during fasting. A good source of protein like dhal and beans are also high fibre and good for health. Although it is an early morning meal, combining your carbohydrate intake with fruits and vegetables is important for your health and blood sugar control.
Breaking fast at sunset (Iftar) with dates is Sunnah and is encouraged in Islam. Dates are high in fibre but also a rich source of carbohydrates. You can only take two large dates combined with a large glass of plain water to maintain your sugar level.
Avoid sugary drinks and reduce all the unhealthy desserts during iftar as this will easily raise your blood sugar. Taking an oily foods or fried foods in moderation is important as this will lead to weight gain despite fasting a whole month during Ramadan.
Watching your salt intake is also important to maintain your blood pressure within the normal range. Remember, you are not only to maintain your blood sugar level but your overall health is of utmost importance.
Lastly, anti-diabetic medication adjustment either oral tablets or injectables is important to prevent hypoglycemia during fasting. It would be best to discuss this with your own doctor, especially the insulin dose and timing of injection.
Although it is mandatory (wajib) for all Muslims, Fasting during Ramadan is not supposed to be detrimental to your health. — The Health
Prof Dr Norlaila Mustafa is Deputy Dean (Postgraduate), Faculty of Medicine and Senior Consultant Physician and Endocrinologist, Universiti Kebangsaan Malaysia Medical Centre.