- Dr V Mohan, Chairman and Chief Diabetologist, Dr Mohan’s Diabetes Specialties Centre Ramadan is…
Diabetes And Ramadan Fasting
Ramadan is one of the holiest festivals of Islam. During the month of Ramadan, all healthy Muslims are supposed to undertake a fast from sunrise to sunset. Even though people with serious medical conditions, including diabetes, can exempt themselves from the fast, a large number will still participate, often against medical advice. The CREED (Center for Research on Entrepreneurship and Enterprise Development) study reported that 94.2 % of individuals with Type 2 Diabetes fasted for at least 15 days and 63.6 % fasted for all days of Ramadan. (1) Ramadan fasting can present a particular challenge to people with diabetes. Health care professionals (HCP) should give focused education to people with diabetes to raise awareness of the risk associated with diabetes and fasting. They should also provide suggestions to reduce the risk of adverse events during fasting.
Fasting during Ramadan can lead to changes in meal schedule, fluid intake and sleep pattern. In people with diabetes, Ramadan fasting is associated with a risk of both hyper and hypoglycemia. These may be due to insulin resistance and increased glucagon levels. The DAR MENA T2DM study showed that hypoglycemia increased significantly during Ramadan (10.4 %) when compared to before Ramadan (4.9 %). (2) Similarly, increased blood glucose levels have also been reported during Ramadan. The EPIDAR study showed that people with Type 2 Diabetes could have a 5-fold increase in glucose levels during Ramadan. (3) Therefore, it is important to analyze the risk profile in persons with diabetes before fasting begins and those who are found to be at higher risk should not fast. It is therefore important to seek medical advice and to consult HCPs before fasting.
The pre-Ramadan diabetes education should focus on six key areas viz.
The role of dietary management is essential for achieving optimal diabetes control. The main points which need to be considered while planning a diet for individuals with diabetes are
The Glycemic index and load should be taken into consideration while planning a diet for people with diabetes and who fast for Ramadan. The Glycemic index (GI) of a food is defined as the inherent quality of that food to raise the blood glucose level. In other words, it is a ranking of foods, based on their tendency to increase the glucose level. Usually, Glucose or white bread is taken as the standard and given a value of 100. If the GI of the test food is 55 or less it is called a ‘Low GI’ food. If it is between 56 to 69 it is a ‘Medium GI’ food, and if the GI is 70 and above, it is called a ‘High GI’ food.
Examples of low GI foods are Greens, green leafy vegetables, non-starchy vegetables, legumes, beans, peas, lentils and nuts.
Examples of Medium GI foods are whole wheat, brown rice, oat bran, muesli, etc
Examples of high GI foods include polished white rice, white bread, maida, corn flakes, potato, sugar, sweets, etc.
The glycemic load (GL) is more important than the actual GI of the food. Glycemic load measures the degree of blood sugar response and insulin demand produced by a specific amount of a specific food. Glycemic load reflects both the quality and the number of dietary carbohydrates.
For example, the GI of food may be high but one person may have a couple of spoons of it, while another may have half a plate of the high GI foodstuff and obviously there is a lot of difference between the two. This is the importance of the concept of GL, which simply multiplies the GI by the amount of the foodstuff consumed
The principles of diet planning during Ramadan are
People with diabetes who chose to fast must regularly check their blood glucose levels through SMBG or CGMS. Monitoring Blood Glucose is more important during Ramadan as changes in diet and lifestyle can increase the incidence of hypoglycaemia and hyperglycaemia. Moreover, by regularly measuring blood glucose, people with diabetes may become more conscious of their eating habits and the impact on their blood glucose levels, potentially curbing damaging behaviours. The frequency of SMBG depends on many factors including the type of diabetes and current medications.
Repeated fasting for 30 days brings some physiological changes in our body, the most favorable of these being that the body starts using energy from body fat stores. However, studies show that 30 consecutive days without performing any physical exercise or activity reduces strength and physical fitness. Thus, working out in a fasting state trains your body to burn fat more efficiently. It is therefore important to remain active in the month of Ramadan.
Benefits of exercise while fasting include
Persons with diabetes who are taking medications likely to cause hypoglycemia such as insulin or sulphonylureas will need to adjust the dosages to reduce the risk of hypoglycemia. It is recommended that patients visit their HCPs prior to initiation of the fast so that the necessary adjustments can be made. Frequent SMBG or CGMS is recommended to allow these adjustments.
Fasting during Ramadan carries a certain risk for patients with diabetes. Persons with diabetes should undergo Pre – Ramadan assessment before starting the fast and should be guided by Health Care Professionals on meal planning, physical activity, glucose monitoring and timings and dosage of medication in order to have safe fasting.
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Authors: Dr. V. Mohan, Chairman & Chief Diabetologist | Ms. Umasakthy, Registered Dietitian Latent autoimmune…