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1. Is it Ok for me to fast during the Holy Month of Ramadan, if I am living with diabetes?
During fasting, about eight hours after the last meal our bodies start to make use of energy stores to keep blood glucose (sugar) levels normal. For most people, this is not harmful.
However, a problem can occur if you are living with diabetes, such as the risk of high glucose levels following the larger meals that we eat before and after fasting at Suhoor and Iftar.
Of course, this year the fasting period is long (15 hours in the UAE) meaning that the risk of Hypoglycaemia (high blood sugar levels) and dehydration (lack of water) are high.
It is very important that anyone living with type 1 diabetes understand that they are at a higher risk compared to those with type 2 diabetes when fasting during the Holy Month of Ramadan.
It is crucial that if you are a type 1 diabetes patient and intend to fast, that you are closely supervised and ensure that your blood sugar is regularly monitored to mitigate health risks.
If you are living with type 2 diabetes, generally it is perfectly safe to fast during Ramadan provided that you talk to your doctor about your plans and prepare yourself well.
But, it is not safe for everyone living with type 2.
Your ability to fast safely often depends on your prescribed medication, and therefore it is really important for you and your doctor to assess your medication programme before the start of Ramadan and/or your fast. Your doctor will guide you to create a fasting plan which works for you.
A lot depends on how well your diabetes is controlled, especially if you're prone to either frequent high blood sugar levels (Hyperglycemia), or low blood sugar levels (Hypoglycemia).
For example, if you are taking certain tablets and/or insulin, fasting carries the risk of Hypoglycaemia, or high blood glucose levels during a fast are a possible risk, and in extreme cases, can lead to Diabetic Ketoacidosis (DKA), a serious condition requiring hospital treatment.
2. What happens to my body during fasting?
During fasting, at about eight hours after the last meal our bodies start to use energy stores to keep our blood glucose (sugar) levels normal. For most people, this is not harmful.
However for someone living with diabetes, especially if you take certain tablets or insulin, you are at risk of Hypoglycaemia (low blood glucose levels), Hypoglycaemia, (high glucose levels) and dehydration (lack of water).
3. If I am living with type 1 diabetes, is fasting risky?
In general, people living with type 1 diabe¬tes are at very high risk of develop¬ing severe complications, and are strongly advised to not fast during Ramadan.
If you are living with type 1 diabetes and really do want to fast, you must consult with your doctor before embarking on the daily fast.
4. What are the risks if I fast and I am living with type 2 diabetes?
If you are living with type 2 diabetes and have successfully embraced a healthy lifestyle by maintaining a normal body weight through a practice of a balanced diet and regular physical activity, the risks associated with fasting are quite low.
However, following a period of fasting if a very large, excessive meal is consumed there is a potential risk of post-meal Hyperglycaemia after the pre-dawn and sunset meals.
One simple solution is to distribute energy intake over two to three smaller meals during the non-fasting interval. This may help you avoid post-meal Hy¬perglycaemia.
As with diet, your daily exercise should be less intense to avoid episodes of Hypoglycaemia.
If you are taking prescribed oral medications and insulin, do consult your doctor to discuss the risks, which will vary from person to person.
5. If I am living with diabetes, do I need to go on a special diet during Ramadan?
The good news is if you are already following a balanced diet, as is recommended for everyone, living with type 2 diabetes or not, then there is a big chance that you do not have to change the ingredients of your diet. In fact you should eat as you normally do, with the only difference being the time you eat your meals, rather than quantity or type of food consumed.
The Ramadan diet should be kept simple and contain foods from all the food groups including:
Bread, cereals or rice
Meat, chicken, fish or beans
Milk, laban or yogurt
Fruits and vegetables
Iftar is the meal that breaks the fast, just after sunset, after the long hours of fasting. It is important however that it remains a meal and does not become a feast!
One other thing to be particularly aware of is the risk of increasing blood sugar levels after Iftar, especially if you eat sweet food.
Also, you must take special care to drink plenty of water during the non-fasting hours, so that you remain comfortably hydrated during fasting hours.
At Suhoor you should eat starchy carbohydrates which release energy slowly, such as multigrain bread, oat-based cereals, basmati rice together with beans, pulses, lentils fruit and vegetables.
Other foods which will keep your blood glucose levels more stable throughout the fast include pitta bread, chapattis and semolina. As with all meals, eat sensibly, do not over eat and remember to drink plenty of water.
6. What are the risks of fasting while living with diabetes during pregnancy?
Pregnant women are strongly advised not to fast, and indeed Islam releases a pregnant woman from fasting during Ramadan. However, some still like to fast and if diabetes (including gestational diabetes) is also present, this is considered a high-risk scenario that requires intensive care.
Pregnancy involves a state of increased insensitivity to insulin and insulin secretion.
During fasting, blood glucose levels are generally lower but post-meal glucose and insulin levels remain substantially higher in healthy pregnant women than in women who are not pregnant.
Elevated blood glucose levels during pregnancy may be associated with increased risk for major congenital abnormalities.
It should also be remembered that the issues concerning the management of type 1 diabetes and type 2 diabetes also apply to pregnant women, along with more frequent monitoring and insulin dose adjustment.
7. Is it Ok for children to fast, and what are the guidelines?
In Islamic teaching, children are not required to fast for Ramadan until they reach the age of puberty. However, in many families, younger children enjoy participating and are encouraged to practice their fasting.
It's important to make children aware of what fasting involves and to then to practice fasting for a few hours at a time, although fasting for children under the age of seven or eight isn't advisable.
Children living with diabetes who choose to fast during Ramadan do pose a management challenge for paediatricians as the majority of guidelines and data on safety and metabolic impact of fasting are based on practice and studies on the adult population.
It is very important that fasting only takes place under the watchful eye of the child's doctor.
8. Here are some recent seasonal quotes from ICLDC's specialists:
ICLDC's Deputy Medical Director, Consultant Diabetologist and Endocrinologist, Dr Saf Naqvi:
“Pregnant women are strongly advised not to fast, and indeed Islam releases a pregnant woman from fasting during Ramadan. However, some still like to fast and if diabetes (including gestational diabetes) is also present, this is considered a high-risk scenario that requires intensive care…”
“It's important to make children aware of what fasting involves and to then to practice fasting for a few hours at a time, although fasting for children under the age of seven or eight isn't advisable. Indeed, in Islamic teaching, children are not required to fast for Ramadan until they reach the age of puberty…”
“It is good to take some moderate exercise just before you break your fast at Iftar, and again just before going to bed, as well as right before Suhoor…”
“It will be quite warm during Ramadan this year and outdoor exercise might not always be the best option, so try climbing the stairs. Start slowly and gradually with two flights at a time and refrain from pushing yourself too hard during the first few days…”
ICLDC's Internal Medicine Specialist, Dr Farhana Bin Lootah:
“Exercise is an important contributor to achieving and maintaining a healthy lifestyle, and can help reduce the risk of developing diabetes by 58 per cent…”
“As simple as it may sound, a brisk walk for 30 minutes a day, five times a week greatly reduces the chance of developing diabetes…”
“Exercise is especially effective in minimising the risk when part of a three-way combination of a regular exercise practise, a balanced diet and maintaining a normal body weight…”
“It makes absolute sense to maintain an exercise practice throughout the Holy Month, just changing the times for exercise and food intake according to the Ramadan guidelines…”
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