Many patients with diabetes insist on fasting during Ramadan, despite the high temperature and long hours during the day, creating a challenge for themselves and their healthcare providers. Doctors believe that diabetic patients can fast provided that they comply with their instructions; however, there are some medical conditions that prevent a patient with diabetes from fasting.
Therefore, the commitment of diabetic patients to the recommendations and guidelines of their doctor, who should be visited before the month of Ramadan, is the most important step that enables the patient to fast without causing any health problems such as sudden increase or drop of their blood sugar level. The diabetic should stick to the quantity and quality of food specified by the nutritionist in order to maintain a good health during fasting while avoiding the consumption of sugar and sweets that can be replaced with fresh fruits. The diabetic patient must also avoid eating fried and fatty foods. It is essential that patients monitor their blood glucose levels multiple times daily during Ramadan in order for them to determine their need of oral medications or insulin injection.
Endocrinologists in the Muslim world have set some rules for the patients with type 1 diabetes who are advised not to fast during Ramadan especially those with brittle type 1 diabetes, patients who take more than 3-4 insulin injections daily or those with frequent hypo and high blood sugar, patients living alone or those with severe kidney or eye complications or who are prone to frequent diabetic ketoacidosis. Type 1 diabetics can also fast but need pre-Ramadan assessment by their doctor or diabetic nurse specialist and advice on insulin regimen change or dose alteration. Any patient with type 2 diabetes suffering from one or more of these symptoms is advised not to fast. Symptoms include urinary albumin with a creatinine ratio greater than 1.5 mg, patients with diabetic retinopathy, who suffer from complications in the heart, blood vessels and brain or who have very high blood glucose level, patients who take several insulin shots daily, pregnant diabetic women and breastfeeding mothers or people suffering from acute ulcer, renal failure, mild heart attacks, severe mental illnesses or defect in liver function.
Patients with Type 1 Diabetes
Type 1 diabetes is the insulin-dependent diabetes and fasting is not advised for these patients especially if they suffer from recurrent blood sugar swings or the diabetic patient is pregnant. It is essential that patients monitor closely their blood glucose levels multiple times daily during Ramadan in order to determine their need of oral medications or insulin injection. Diabetic patients should follow the health guidelines advised by their doctor while frequently monitoring their blood glucose level in order to adjust the insulin dose. Monitoring glucose level gives the diabetic patient an idea whether he is able to continue fasting during the holy month. The fast should be immediately broken if blood glucose suddenly decreases because it will drop further if treatment is delayed.
Drugs used by diabetic patients differ depending on the type of treatment whether it was a drug or insulin regimen especially during the month of Ramadan. If the patient takes tablets once in the morning, he must take them with Iftar meal while taking into consideration to change long-acting hypoglycemic drugs to short-acting drugs in order to prevent hypoglycemia. If the patient takes tablets twice a day, he must take one with Iftar and the other with the Suhur meal. While patients who need one dose of insulin should take the injection right before the Iftar meal and those who need two-dose insulin (day and night) are recommended to ask their doctor to avoid any risk of hypoglycemia or hyperglycemia.
Patients with Type 2 Diabetes
Patients with type 2 diabetes, noninsulin-dependent diabetes, can fast. This type of diabetes occurs when either the body makes too little insulin or the cells do not respond to insulin that is produced. Patients with type 2 diabetes may be able to control their blood sugar levels by following a diet, exercise program and losing excess weight. Studies suggest that it is useful for patients with type 2 diabetes to fast during Ramadan provided that their condition does not require them to take drugs continuously throughout the day to treat their blood sugar level.
Most importantly, these patients must avoid everything that may cause their blood sugar levels to increase or drop so they don’t cause any damage to their body organs, and not be forced to break their fast. If there are signs of hypoglycemia or hyperglycemia, fasting should be broken immediately and the patient should eat something in order to maintain a normal blood sugar level and prevent serious diabetes complications.
Patients with diabetes should follow a specific diet in order to maintain a normal blood sugar level and avoid serious complications. They should know that the healthier their diet, the more they will be able to fast without any serious health problems. Usually, breakfast should contain one date, sufficient amount of water, soup which is necessary to prepare the stomach, and then the patient should take his medicine and have a simple break that may be used to perform the prayer. After that, the patient consumes a small breakfast consisting of rice or a loaf of brown bread, a sufficient amount of vegetables, and a medium piece of meat or fish. He can also eat a fruit after an hour.
The diabetic patient should consume three meals, one at Iftar and one at Suhur then a third meal; they should also drink plenty of water and fluids and avoid sweetened juices due to their high sugar content. Also, fluids should be distributed throughout the night and not be drunk at once. He should also eat a small portion of Ramadan desserts and check his blood sugar level more often than on regular days.
Diabetic patients are recommended to monitor their blood glucose level before and 2 hours after every meal in order to adjust the insulin dose. They should also reduce salt intake because it significantly increases the risk of kidney and heart disease in people with diabetes. Patients should not eat large food portions at Iftar as well as foods high in fat or carbohydrates, and should start eating a small amount of simple carbohydrates that can be absorbed quickly by the body such as dates.
Suhur should consist of a sufficient amount of carbohydrates, a loaf of brown bread with one egg or low-fat cheese. Sweets and sugary juices must be avoided and the patient must drink plenty of water and avoid soft drinks. Suhur meals include a large amount of safe proteins because they are slow to be absorbed, and the blood sugar level does not increase after the meal, giving a feeling of satiety for as long as possible. It is also advised to eat complex carbohydrates in the first Suhur meal in Ramadan in preparation for fasting the first day.
Dietary guidelines for patients with diabetes who wish to fast include:
- Sticking to the diet, medication and guidelines regarding the food quantity allowed during Iftar and Suhur.
- Patients with diabetes are advised to have Iftar and Suhur and a snack in between.
- Drinking plenty of fluids such as soup, milk, water and unsweetened drinks.
- At Iftar, it is preferable to start with a simple sugar like two dates with yoghurt or half a glass of fresh fruit juice.
- Avoiding traditional Ramadan drinks such as licorice and Qamar ad-deen (or apricot juice) and replace them with yoghurt or natural fruit juice.
- Following healthy food instructions for patients with diabetes.
- Avoiding the use of meat extracts when preparing soups and replacing them with chicken broth while following the right method.
- The patient with diabetes can eat two pieces of Atayef two hours after Iftar.
- Diabetics are advised to have some sugar cubes, sweets or dates handy to reach for them directly when experiencing hypoglycemia symptoms.
- Using spices, onions, garlic and lemon to add flavor when preparing meals instead of butter and salt.