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Diabetes Management during Ramadan

I was reading the August 2010 issue of Centerpoint Priveleges magazine and I can't help not to share this timely article published about diabetes management during the fasting month. I am willing to spread the news for the benefit of those who fast as well as those who don't but are diabetic patients and of their family.

It is good to know that something can be done to avoid unlikely situations.

Fasting during Ramadan is an obligatory duty of every healthy adult Muslim. While fasting, they abstain from eating, drinking, use of oral medications and smoking from predawn to after sunset however there are no restrictions on food and drink intake between sunset and dawn. The Holy Quran specifically exempts the sick fromt he duty of fasting especially if it can lead to harmful consequences for the individual and diabetic patients fall under this category. Nevertheless, many diabetics insist on fasting during Ramadan, therefore it is absolutely necessary that the patients are aware of the risk posed and the precautions required while observing the fast. The medical ramifications of fasting among patients with diabetes are largely unknown.

However the major risks associated are as follows:

Hypoglycemia or low blood sugar level
Hyperglycemia or high blood sugar level
Diabetic Ketoacidosis or fatal state of no insulin defeciency, high blood sugar and dehydration
Dehydration and thrombosis or formation of blood clot

There are precautions for type 1 and type 2 diabetes

Patients with type 1 diabetes are at very high risk of developing serious complications and should be strongly advised against fasting during Ramadan. Also patients unwilling or unable to measure their blood glucose levels multiple times daily are at high risks and should be advised not to fast at all.

Patients with type 2 diabetes who control their diet well, the risk associated with fasting are quite low. However, there is a potential risk of hih blood sugar level after predawn and sunset meals if patients indulge in overeating. Distribution of calories over 2-3 meals during the non fasting interval may help prevent excessive postmeal hyperglycemia.

Severity of risks in patients with type 1 and type 2 diabetes who fast during Ramadan

Very High Risk
-Very low blood sugar level within the last 3 months prior Ramadan
-Patients with a history of recurrent low blood sugar
-Patients will poor blood sugar control
-Ketoacidosis within the last 3 months prior to Ramadan
-Acute Illness
-Type 1 diabetes
-Patients who perform intense physical labor

High Risk
-Patients with moderately high blood sugar level (average blood glucose between 150-300 mg/dl)
-Patients with renal insufficiency
-Old age patients with ill health

Moderate Risk
-Well controlled patients treated with short acting insulin secretogogues

Low Risk
-Well controlled patients treated with diet alone and who are otherwise healthy

Patients who insist in fasting should undergo medical assessment 1-2 months before Ramadan and should also receive necessary counseling on self care, signs and symptoms of hyper and hypoglycemia, blood glucose monitoring, meal planning, physical activity and handling acute complications.Being aware of the risk associated and the need to adhere to recommendations of their doctor helps the patient achieve a safer fasting experience.

Several Issues must be considered while fasting during Ramadan

-The most crucial concern is the realization that care must be highly individualized and is different for each patient
-It is essential that patients measure their blood sugar glucose levels multiples times daily
-Diet during Ramadan should not differ significantly from a healthy and balanced diet. The practice of eating food rich in carbohydrate and fat, especially for the sunset meal should be avoided. Though intake of food containing complex carbohydrates is always advisable.
-Fluid intake must be increased between sunset and dawn and the predawn meal should be taken as late as possible before the start of the daily fast.
-Normal levels of physical activity must be maintained but with more vigilance
-All patients should break their fast immediately in case of low blood glucose level symptoms and should avoid fasting during sick days.

Kindly note that I am not a health care provider/practitioner, the above article is posted for the purpose of disseminating information and creating awareness about Diabetes Management during Ramadan.