Major risks associated with fasting in patients with diabetes:
Hypoglycemia
Hyperglycemia
Diabetic ketoacidosis
Dehydration and thrombosis
All patients with diabetes (especially those with type 1 diabetes) who wish to fast during Ramadan should prepare by undergoing a medical assessment and engaging in a structured education program to undertake the fast as safely as possible. This assessment should take place ideally 1–2 months before Ramadan.
Management:
Individualisation: Ask to your health expert to plan a diet/exercise regime that fits within your schedule based on your current blood parameters.
Frequent self monitoring of glucose is crucial.
Diet: Eating large amounts of foods rich in carbohydrates and fats, especially at the sunset meal, should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing “complex” carbohydrates (slow digesting foods) may be advisable at the predawn meal, which should be eaten as late as possible before the start of the daily fast. It is also recommended that fluid intake be increased during non fasting hours. Distributing calories over two to three smaller meals during the non fasting interval may help prevent excessive postprandial hyperglycemia.
Break the fast if: hypoglycemia (blood glucose of <60 mg/dl) occurs because their blood glucose may drop further if they delay treatment. The fast should also be broken if blood glucose reaches <70 mg/dl in the first few hours after the start of the fast, especially if insulin, or other medications are taken at predawn.
Exercise: Normal levels of physical activity may be maintained. However, excessive physical activity may lead to a higher risk of hypoglycemia and should be avoided, particularly during the few hours before the sunset meal. Physical activity may be modified in its intensity and timing, e.g., ∼2 h after the sunset meal.
Medication: will need to be adjusted in line with the fasting/non fasting hours.
Guest Article, Dietician Shwetha Bhatia