Diabetic Patients and Fasting in Ramadan
BY: Dr. Sameh Ahmed Ghareeb/Contributing writer
(May Allah accept this article as a Sadaqa in behalf of the soul of my late dad)
Around 50 million people with diabetes worldwide fast during Ramadan. For the next few years, Ramadan in the US will be in the summer months, and the length of fasting is very long (+-17 hours).
Quran exempts patients from fasting if fasting might lead to harmful consequences (Holy Koran, Al-Bakarah, 183–185). Patients with diabetes fall under this category because their chronic metabolic disorder may put them at high risk for complications if the pattern and amount of their meal and fluid intake is markedly altered. Long hours of fasting put diabetic patients at higher risk of hypoglycemia (lower blood glucose level than normal) and dehydration (lack of water), which could be serious if they are severe. Hyperglycemia (higher blood glucose level than normal) can also happen if diabetic patients eat excessively large meals at Iftar or Suhoor.
Nevertheless, many patients with diabetes insist on fasting during Ramadan, thereby creating a medical challenge for themselves, their families, and their physicians. It is therefore important that patients, families, and professionals be aware of potential risks that may be associated with fasting during Ramadan. In this article, I will answer the most frequently questions asked by diabetic patients in Ramadan:
- What happens to my body when I fast?
Our bodies always try to maintain normal blood glucose (sugar) levels by producing hormones such as insulin and glucagon. When we don’t eat when fasting, our bodies start using stored carbohydrates (sugar) and fats as source of energy to keep our blood glucose levels normal. This usually happens normally with no harm. But in patients with diabetes, especially those who take tablets or insulin, risk of hypoglycaemia and dehydration, as well as hyperglycemia.
- I have diabetes, can I fast?
I will not recommend or not recommend diabetic patients to fast or not, as fasting is a religious issue and patients should make their own decision based on their own condition and after consulting their health care providers.
Islam is a religion of peace and ease, so anyone who would put their health at serious risk by fasting, such as patients who takes insulin and/or certain medications, people who have diabetic complications (damage to eyes, kidney, or the nerves in their feet), or people who have poor control of their diabetes could be exempted from fasting. This exemption that was mentioned in Quran was supported by the Prophet Mohammad who said, “God likes his permission to be fulfilled, as he likes his will to be executed.”
You must speak to your primary care provider, your diabetes nurse, or diabetes doctor about your diabetes treatment as early as possible.
- I know many people with diabetes who fast and don’t have a problem. Is it okay for me?
It is true that many people with diabetes fast without problems, but each person is different. There are two different types of diabetes and different medications and insulin injections that patients with diabetes take. Also, hyperglycemia in some patients is severe while in other patients is mild. So, the best decision is to consult your health care providers to discuss your status and safety of your fasting and/ or to change your medication plan.
- Is it Okay to test blood glucose level while I am fasting?
Yes, testing blood glucose level will not break your fast. Actually, testing blood glucose levels regularly is important and will keep you safe while fasting.
- Do I need to wake up at Suhoor?
As we have mentioned, long hours without eating increases the risk of hypoglycemia, especially for those who take diabetes pills or insulin. So, it is highly recommended to eat and drink at Suhoor; this will help to keep glucose levels more balanced through the day.
- What should I eat at Suhoor?
It is recommended to eat starchy carbohydrates (such as multigrain bread, oat-based cereals, and basmati rice) as well as some protein and minimal fat to help slow the digestion and help the feeling of fullness last as long as possible into the day. Starchy carbohydrates release energy slowly. It is recommended also to eat beans, pulses (dried seeds), lentils, and fruit and vegetables. You may also eat pitta bread, chapattis, and semolina. Remember to not over eat and remember to drink plenty of sugar-free caffeine-free drinks fluids, particularly water.
- What can I eat and drink on Iftar?
Traditionally Iftar begins with the eating dates and drinking water. Limit dates to 1-2 each evening as they are full of sugar. Drink plenty of water and sugar free beverages throughout the evening, but avoid caffeine beverages as they can be dehydrating. You may eat whole grains, lean sources of meat, fish and poultry, small amounts of heart healthy fats and limit added sugars.
Recommended options include:
- Whole grain cereal, low-fat milk, cottage cheese with sliced peaches topped with toasted almonds
- Plain Greek Yogurt flavored with blueberries and cinnamon, whole wheat toast with nut butter.
- Foul (fava beans), small serving of sliced fruit
- Whole wheat roti (unleavened bread) and egg khagina (a southeast Asian dish)
It is very important to eat in moderate portions and not to over overeat, and avoid fried foods and foods high in fat and sugar (fries, regular soda, desserts…etc). Consult your dietitian for specific daily plan.
- Do I stop taking medications during Ramadan?
No. Continue taking your diabetes medicine. However, times and doses would be different. This is why it is very important to talk with your healthcare providers.
- How is hypoglycemia (low blood sugar) treated?
If glucose levels fall below 70, take 15 grams of carbohydrate in the form of one of these: 4 glucose tablets, 6 oz regular soda, 4 oz fruit juice, or 1 tube glucose gel. Wait 15 minutes and recheck again. Follow with a snack if the evening meal is not for more than an hour.
- What do you advise me if I decide to fast?
If, after consulting with your doctor, you decide to fast, here are some tips:
- If you are taking insulin, you will need less morning insulin dose (Do not change the dose without consulting your diabetes team).
- The type of insulin may also need changing from your usual type
- Pre-mixed insulin is not recommended during fasting
- Before starting the fast, you should include more slowly absorbed food (low GI), such as basmati rice and dhal, in your meal, along with fruit and vegetables
- Check your blood glucose levels more often than you normally would
- When you break the fast, have only small quantities food, and avoid only eating sweet or fatty foods
- Try to eat just before dawn.
- After sunset, drink plenty of sugar-free and decaffeinated fluids to avoid being dehydrated.
Conclusion
There is no strict recommendation for diabetic patients regarding fasting in Ramadan. It is a personal choice to fast or not. Nevertheless, it is very important to consult your diabetes healthcare team in order to provide you with the best advice and modify your treatment in order to ensure your safety. Failing to do so is in itself contrary to the Qur’an, which clearly states that you must not act in a way that harms your body.
Remember, if you cannot fast, you can complete your duties by offering charity or providing food to the poor. And if you cannot fast this Ramadan because of the hot long hours, you may be able to make up the fast at a later date during the winter months. Speak to your local Imam for more information about this.