Sunday | 6 October 2024 | Reg No- 06
বাংলা
   
Sunday | 6 October 2024 | Epaper

Ramadan fasting tips for diabetics

Published : Sunday, 3 April, 2022 at 12:00 AM  Count : 1133
ZUBAIR KHALED HUQ
Ramadan is knocking at the door! Diabetic and want to fast? You have to find out whether diabetics should fast, and if they can, what they should eat and avoid. Check your blood glucose levels more often than you would check on days when you are not fasting. Take a diet plan, anti-diabetic drugs or insulin as per doctor's advice. Your doctor may make some changes as per your fasting schedule.

The main concern for diabetes management during Ramadan is hypoglycaemia. Fasting can disrupt normal glucose homeostasis and lead to serious consequences. Patients who choose to fast with diabetes should be warned of these complications. Based on medical advice, it is recommended to visit your doctor a few weeks before Ramadan to understand your risk and consequences. Creating a plan for nutrition during Ramadan is essential to ensure safe and confident fasting.   

It is very important to select the right and healthy foods. Selecting wrong and unhealthy foods may cause an imbalance in the blood glucose levels. Once you break your fast in the evening, eat small, healthy and nutritious meals. Be wise about the portion size. Do not overeat. Do not break your fast with foods that are deep fried or laden with sugar. Avoid eating large and heavy meals in one go. This may lead to acidity, bloating and discomfort. After you break your fast, drink healthy fluids. Water is the best fluid you can drink. Avoid drinking sherbet, fruit juice, packaged drinks and other sugar-sweetened beverages. Caffeinated beverages such as coffee, soda and fizzy drinks are strictly not recommended because these drinks can further lead to dehydration.    

Treatment is very important if your blood glucose level is high or too low. If you feel confused, disoriented and unwell, immediately check your blood glucose level. These can be indications of hypoglycaemia. Experts advise that if the blood glucose levels drop below 70mg/dL, it is better to break the fast. When type 2 diabetes patients follow a very low-carbohydrate or low-calorie diet, there is a need to reduce or eliminate glucose-lowering medications. Drink plenty of water and sugar-free beverages after breaking the fast. Add salads to the meals to increase the fibre intake. Include plenty of fresh fruits and vegetables with high water content.    

Carbohydrates provide a lot of energy but can be less good for blood sugar levels, particularly for people with type 2 diabetes. Carbohydrates with a low glycaemia index such as brown rice, full grain bread and vegetables are better options than white rice, on-full grain bread or potatoes. Eat a balanced meal after a fast. One has to make sure it's not just carbohydrates.

A meal that combines protein, fibre and healthy carbohydrates can help keep your body and blood sugar in balance at anytime, but especially after fasting. Check your blood glucose regularly, improvements in blood sugar tend to be dependent on fasting. Your blood sugar will typically improve after 2-4 weeks of compliance with a fasting protocol. The bigger dose of anti-diabetics medication should be taken at iftar. It may be prudent to choose anti-diabetic agents that have a lower risk of hypoglycaemia.  

If you usually take long-acting insulin in the morning, take half your usual dose on sohur. If you usually take it at iftar, take half your usual dose. After the fasting is over, take all your usual dose at the usual time. Can you fast if you have diabetes? Yes, but it depends on how healthy you are. Blood glucose monitoring and insulin injections do not break the fast and are important. People at very high risk should check blood glucose levels 3-4 times a day. People at moderate or low risk should check blood glucose levels 1-2times a day. For medication adjustments during fasting, consulting your doctor about the adjustments required to the dose, timing or type of medication to reduce the risk of low blood sugar is vital.

Regular adherence to your other medications including blood pressure, heart and cholesterol tablets is a must. Other medications may need no dose adjustments.   When to break the fast is the big question, if you feel really bad. All patients should understand that they must always and immediately end their fast if blood glucose is lower than 3.9 m mol/L. Re-check within one hour if blood glucose is in the range. Blood glucose higher than 16.6 m mol/L. Symptoms of hypoglycaemia, like sweating, dizziness, tremor, fainting one should break the fast immediately to save life. Hyperglycaemia, dehydration or acute illness may occur at any time, look for causing blurry vision, headache, increased fatigue and thirst.

All situations can be misleading, soon should not take chances. Normal levels of physical activity may be maintained. However, excessive physical activity may lead to a higher risk of hypoglycaemia, dehydration and should be avoided, particularly during the few hours before the iftar. Physical exertions involved in prayers should be considered part of your daily exercise activities. Dietary advice for people with diabetes during fasting, one should divide daily calories between Suhoor and Iftar, plus 1-2 snacks if necessary. Include plenty of fruit, vegetables and salads, minimize foods that are high unsaturated fats, use small amounts of oil when cooking. Stay hydrated at or between the two main meals by drinking water or other non-sweetened beverages. One should avoid caffeinated, sweetened drinks and sugary desserts.

Along with reduction of body weight, BMI, blood pressure and lipid profile, Ramadan fasting appeared to reflect beneficial effects on glycaemic status of patients.  If you are on insulin and decide to fast you must not stop your insulin but will have to have the dose adjusted after advice from a health care professional. For adults with type 2 diabetes needing insulin initiation just prior to or during Ramadan, a basal, long-acting insulin detemir, glargine maybe preferred over intermediate acting basal or premixed insulin options during the fasting month to reduce the risk of hypoglycaemia. The dose of premixed insulin should be 50% in evening dose and be taken at sohur, morning dose at iftar can be taken at full dose.

In case of short, ultra-short acting insulin full morning dose at iftar, lunch dose is omitted, 50% of night dose at sohur. In case of long-acting insulin Glargine, Detemir reduces 15-30% and takes at iftar.   In case of pregnant diabetics, not within target must not fast. Type 1 diabetics, CKD stage 4, 5, hypoglycaemia, hyperglycaemic hyperosmolar state, last three month of pregnancy have high risk. They must consult their physician before going for any change, since that can be fatal.

Agents that have a low risk of hypoglycaemia like metformin, DPP-4inhibitors, Glitazone, SGLT2 inhibitor need no dose adjustment, just morning dose at ifter evening dose at sohur, can be used safely during Ramadan. If taking Sulfonylurea reduce the evening dose by fifty percent and take it at sohur, morning dose at iftar in full. If taking once daily dose then full should be taken at iftar like gliclazide MR, glimepiride. A cornerstone of managing diabetes during Ramadan is patient education, which should include information on risks, glucose monitoring, nutrition, exercise and medication.
Dr Zubair Khaled Huq, Family Medicine, Gerontology, Public Health Specialist





LATEST NEWS
MOST READ
Also read
Omicron BF.7
2022 stories that could still have an impact on our lives
Dealing environment with data
Foreign interference in internal affairs
Management factor in our health sector
Diplomatic norms and code of conduct through the lens of international law
Dealing air pollution in winter
Germany to suspend humanitarian aid for Afghanistan
Editor : Iqbal Sobhan Chowdhury
Published by the Editor on behalf of the Observer Ltd. from Globe Printers, 24/A, New Eskaton Road, Ramna, Dhaka.
Editorial, News and Commercial Offices : Aziz Bhaban (2nd floor), 93, Motijheel C/A, Dhaka-1000.
Phone: PABX- 41053001-06; Online: 41053014; Advertisement: 41053012.
E-mail: info©dailyobserverbd.com, news©dailyobserverbd.com, advertisement©dailyobserverbd.com, For Online Edition: mailobserverbd©gmail.com
🔝