Fasting With Diabetes Type 2

About 3 billion Muslims in the world which is about 37.5% of the total population. Currently, the number of diabetes patients in the world is about 450 million. In 2040, it will increase to 642 million. Among them, adults and healthy Muslims usually have fast in Ramadan. 36% of the world's total Muslim adults suffer from diabetes. As it stands, 9-12 crore diabetics patients are fasting every month of Ramadan. Through a reserach we found that 43% of type 1 diabetics and 79% of diabetics patients fasting with diabetes type 2 during Ramadan.

Fasting With Diabetes Type 2

During fasting a person has to fast from dawn till sunset. Depending on the geographical location and season, this period can be from 14 hours to a maximum of 23 hours. In our country the time between Sehri and Iftar can be maximum 18 hours. There has been much debate over the years as to whether or not a diabetic should fast for this long. Finally, Muslim and non-Muslim diabetes experts of the world unanimously agreed that fasting would be harmful for diabetic patients at risk. The Qur'an also exempts the sick from fasting (Surah al-Baqarah: verses 183-185) and diabetes is more closely associated with regular and moderate food intake than any other disease. If a diabetic patient does not eat for a long time due to the disturbed metabolic system, it can cause various physical problems. No diabetes specialist would recommend fasting to an at-risk diabetic. But if a diabetic patient wants to fast due to religious interest, then it is not possible for anyone to forbid him. Here we will discuss all the problems that may arise due to diabetic fasting and how to avoid them as much as possible.

Risks of diabetic patients during fasting

1. Blood Glucose Levels Decrease (hypoglycemia):

If you stop eating for a long time, the blood glucose level decreases. Blood glucose levels in diabetics can drop so low during fasting that they may even need to be hospitalized. The probability of such hypoglycemia is 4.7 times higher in type 1 diabetics and 7.5 times higher in type 2 diabetics.

2. Blood Glucose Levels Inecrease (hypoglycemia):

Both type 1 and 2 diabetics are at risk of elevated blood glucose levels due to fasting. It can be fatal in patients with type 1 diabetes. However, in some cases it can also lead to death. The possibility of these incidents increases towards the end of the month of Ramadan.

3. Diabetic ketoacidosis:

Patients with type 1 diabetes can sometimes become critically ill due to hyperglycemia or the subsequent increase in ketone bodies. Especially in those whose blood glucose control was not good before the start of the fast. This can also be the case with type 2 diabetes patients.

4. Dehydration and thromboembolism:

Abstaining from drinking water or food for a long time while fasting can lead to dehydration. And dehydration can be more pronounced in hot and humid climates. Those who have to do hard physical labor while fasting are also at risk of dehydration. In addition, high levels of glucose in the blood increase the rate at which water and minerals are removed from the body. This can cause dizziness when standing up from a sitting or lying position. In particular, those who have developed neurological problems due to diabetes are more likely to experience sudden loss of consciousness, dizziness, injuries, broken bones, etc. Due to lack of water in the body, the central vein of the retina is blocked by blood clots and the loss of vision has occurred in Saudi Arabia and other desert regions.

Management Of Diabetes During Fasting:

Fasting for a diabetic patient is an entirely personal decision that can pose serious health risks and is a challenge for his physician. Every diabetic patient comes at a lower risk during fasting.

What Should To Do In This Case:

1. Each fasting diabetic patient needs to be considered on its own merits.

2. Blood glucose levels should be monitored frequently [blood glucose should be measured several times (at least three times) per day]. Blood glucose monitoring should be done at the end of the day. And in patients with type 1 diabetes, blood glucose should be monitored very carefully. In the early days of Ramadan, one should be a little more careful, then a decision can be taken based on the situation.

3. Try to keep the nutritional value of the daily diet the same as at other times, although it may not be easy. Steps should be taken to maintain a normal body weight. Research shows that 20%-25% of diabetes patients lose or gain body weight by fasting during Ramadan. Fatty foods and fried foods should be avoided as much as possible at Iftar. Because these foods will take time to digest. But it is important to provide blood glucose as soon as possible to the diabetic patient after iftar. That is why complex carbohydrates should be eaten during fasting. And eat simple vegetarian food at Iftar. Drink plenty of water and other liquids. The sehri meal should be eaten just before the end of the prescribed time (ie it is better if the sehri ends just before the Fajr call) and then it is recommended to drink plenty of water.

4. Normal physical activities including physical labor or exercise can be carried out during this time. But it is better not to do too much hard work or exercise. This can cause hypoglycemia. And hard work cannot be done in the afternoon. If Tarawi prayer is offered, it can be considered as a substitute for physical labor. Hypoglycemia is often fatal in some diabetics (especially type 1) whose blood glucose cannot be maintained properly.

5. Every Diabetic Faster should understand very clearly that any glucose/sugar/sweet food, syrup etc. should be consumed as soon as possible after any symptoms of hypoglycemia appear in the body. People who have hypoglycemia can easily recognize its initial symptoms. And for those who have not had such experience, they may experience one or more symptoms such as chest tightness, lightheadedness, sweating, increased heart rate, dark vision, dizziness, etc. Then hypoglycemia (blood glucose is usually 3.3 mmol/liter) should occur. Again, if the blood glucose drops to 3.9 mmol/liter or more within a few hours of the beginning of the day, it is important to eat something. And those who are taking medicines like insulin, sulphonylurea-meglitinide, are more likely to do so. Again, even if the blood glucose is more than 16.7 mmol/liter, fasting will not be possible.

Pre-Ramadan Assessment:

Diabetic patients who are determined to fast despite knowing all the risks of fasting with diabetes, should undergo the necessary tests at least 1 month before starting the fast. These include blood glucose, fasting blood lipids, liver, kidney and heart function tests and HbA1c etc. after waking up and 2 hours after meals (4 times in total).

Everyone should be interested in taking necessary steps to maintain his own good health. Doctors will help them in this. However, it would be the most prudent course of action for a diabetic patient to start preparing for fasting 3 months before Ramadan.

Dietary Management Of Diabetic Patients During Fasting:

Diabetic patients should be most careful in food management while fasting. The next section discusses this in detail-

Sehri should be eaten shortly before the end of the Sehri meal.
It is better not to take too much sweet and fatty food during Iftar.
Diabetic patients should consume sufficient amount of water and nutritious food so that they do not suffer from dehydration. If you eat dates, you can eat one date. It is better to list fruits, vegetables, pulses and sour yogurt. You can drink bottled water. If drinking any beverages, it is best to choose sugar-free water. If you prefer sweet drinks, you can use sweeteners such as Canderal, Zero Cal or Sweetex (but it is healthier to avoid these as well). You can eat fried foods like onions, green beans, puri, paratha kebabs in small quantities.
The amount and type of food should be fixed by keeping the calories of the food. It is necessary to eat the right amount at the right time.
The amount of caloric food that you used to eat before Ramadan should be changed while maintaining the same amount of calories in Ramadan. If necessary contact the nutritionist and fix the food list. It should be observed that food should be compatible with medicine. Overeating during Iftar and eating less in the last night should be avoided, rather the opposite may be the case.

Reconciliation Of Medicines In Fasting Diabetic Patients:

Those taking 1-times-a-day diabetes medication (medications that increase insulin levels) should take it at the beginning of Iftar (breaking the fast), but the dose may need to be slightly reduced.
People who take diabetes medicine multiple times a day can take the morning dose at the beginning of Iftar and half of the night dose half an hour before Sehri.
For those patients who take insulin, it is important to determine the type and dosage of insulin before Ramadan. It is generally better to take long-acting insulin during Ramadan. Long-acting and low-risk insulins that are taken once daily, such as insulin Lentus or insulin Tresiba, or once to twice daily, such as insulin Levemire, are less likely to cause hypoglycemia. Those who used to take insulin (pre-mixed) 2 times in the morning and before dinner before fasting, should take the same amount of morning dose before Iftar, and half of the night dose before Sehri.

Diabetic Patients Exercise During Fasting:

Exercise is very important for diabetic patients but fasting patients should not exercise more during the day as it can lead to hypoglycemia. It is better to exercise at night especially after Tarabi Namaz. It should be remembered that a long Tarawih prayer takes some exercise.

Specially Need To Know:

Diabetic patients may be able to fast. However, preparations should be take after consulting the doctor 3 months in advance. Do not self-adjust diabetes medications while fasting, as this can have serious consequences. Sehri food should be eaten shortly before the end of Sehri. Don't eat too much sugary food during Iftar. During fasting one should not do excessive exercise during the day. It can cause hypoglycemia. Adequate amount of water (canned water if possible), less sweet juicy fruits and nutritious food should be consumed at night during fasting. It should be remembered that the medication and diet management will change completely during the fasting period and after Ramadan, the normal diabetes treatment should be resumed.