Dubai Health Authority's Twitter Clinic highlights precautions for diabetics who fast during Ramadan.

Dubai, United Arab Emirates, Dubai, July 3, 2014: Dubai Health Authority's Twitter Clinic @DHA_Dubai, highlighted today precautions for diabetics who fast during Ramadan.

The panel of experts at the clinic included specialists from Dubai Hospital and the Dubai Diabetes Center, a specialised multi-disciplinary diabetes care and management centre.

Dr Mohammed Belal Alshammaa, consultant endocrinologist at Dubai Diabetes Centre (DCC) said:  “A majority of our patients prefer to fast during Ramadan despite having diabetes. While they are aware that they are exempt from fasting , they are keen to follow all the rituals of Ramadan. Therefore, we at the DHA provide them with all the information and medical advice necessary to ensure they do not suffer from complications of fasting.”

The DHA endocrinology and diabetes centres meet with patients prior to the Holy month of Ramadan to check if the patient is medically capable of fasting as well as to adjust their medication and provide an individualized diet plan. “The most important step for any diabetic who chooses to fast is to ensure he visits a health practitioner so that the doctor can advise whether it is safe for him to fast and to gauge whether his body will be able to manage long hours of fasting. Once that is ascertained, the patient needs to modify the medication dosage- usually lower the dosage- to ensure they maintain their sugar levels.”

He added that self-monitoring of blood sugar is not only permitted but also essential during fasting and should be effectively utilized to avoid hypoglycaemia or hyperglycaemia, especially during the first few days of fasting.  He said: “ During the first week, it is advisable to monitor the blood sugar several times a day- when the patient wakes up, before Asar prayer, before Iftar, two hours after Iftar and at Suhur so as to understand the pattern of their blood sugar levels and to adjust their medication if needed. If the sugar level is erratic, the patient should visit their doctor.”

Dr Fathiya Al Awadi, head of endocrine unit at Dubai Hospital, elaborated: “Self-monitoring of sugar, timely medication and right diet are all steps that diabetics need to take especially since their body does not have the ability to control fluctuations in blood sugar level.  They also dehydrate faster especially when their sugar levels rise, therefore they need to ensure they take sufficient precautions to maintain their sugar levels while fasting.

“Diabetics who are insulin dependent, i.e. primarily type 1 diabetics are considered to be high risk groups and usually we advise them not  to fast because they are at a higher risk of developing hyper or hypoglycaemia.  Type 2 diabetics can fast after adjusting their medication in consultation with their doctor and following all the recommendations.”

Zeina  Younes, dietician at the Dubai Diabetes Centre said: “A drop or rise in the sugar level for diabetics can cause symptoms , like weakness, shaking of the hands, difficulty in speech, heart palpitations etc. Therefore as a precaution, all diabetics should always have a sugar source at hand that is fast-acting such as glucose gel or tablets, fruit juice, sugar, honey or dates, which they need to consume, if they are experience low sugar.”

Sarnerh Athamnah, diabetes educator at the Dubai Diabetes Centre, said: “Fasting requires the mind and body to adjust and adapt to the new routine and to make sure this is a smooth transition, preparation is key. Therefore, in addition to diet and medication modification, we educate patients about the guidelines and dos or don'ts during the fasting period.”

General Guidelines to Keep in Mind:

• DO NOT skip meals (Suhur/Iftar) during Ramadan.

• Enjoy a light meal at Suhur rather than having a meal at midnight – eat wholegrain breads, oatmeal or high-fibre cereals with 1 cup low-fat/fat-free milk and  1 piece of fresh fruit.

• At Iftar, eat slowly-absorbed foods such as beans and lentils in addition to lean meat, fish or chicken, low-fat/fat-free milk or yogurt and  consume plenty of vegetables and  a serving of fresh fruit.

• Avoid high-calorie, processed and  salty foods.

• Limit fried and  fatty foods such as paratha, puri, samosas, chevera, pakoras, katlamas, fried kebabs and Bombay mix to one portion. Measure the amount of oil used in cooking (use 1–2 tablespoons for a four-person dish).

• Limit intake of sweets and  desserts as much as possible.

• Try to stay within your carbohydrate budget.

• Drink enough water and/or sugar-free beverages between Iftar and  Suhur to avoid dehydration.

• Avoid overeating at meals.

• Take your medication and/or insulin as prescribed.

• If you want to exercise, it should be two hours after Iftar. Tarawih prayers are considered as part of the exercise program.

• Avoid exercise during the hours of fasting.

Who should NOT fast?

1) Patients who have had severe low blood glucose 3 months prior to Ramadan.
2) Patient with a history of recurrent low blood glucose.
3) Hypoglycemia unawareness.( diabetic patients with low blood glucose who do not have any symptoms of low blood sugar and are NOT aware of the hypoglycemia).
4) Patient who are NOT controlling their diabetes well, especially those with diabetes Type 1.
5) Those who had Diabetic Ketoacidosis  3 months prior to Ramadan.
6) Diabetic patients who are pregnant.
7) Diabetic patients with renal failure and/or are on dialysis.