Things to consider in fasting with diabetes during Ramadan

Fasting during Ramadan can pose significant challenges for individuals with diabetes due to changes in meal timings and potential fluctuations in blood sugar levels, changes in sleep patterns, and circadian rhythms. 

Here are a few tips for safely fasting with diabetes during Ramadan:

• Consultation with endocrinologist/hormone specialist: Before starting fasting, consult with your healthcare provider to assess your overall health and discuss whether fasting is safe for you. They will provide personalised guidance based on your individual health status and diabetes management plan. The best time to consult an endocrinologist/hormone specialist is 2-3 months before the Ramadan onset. That will prove ample scope to improve glycemic control.

• Monitoring blood sugar levels regularly: Monitor your blood sugar levels regularly, especially during fasting hours. Check your blood sugar levels before fasting begins, during the day, and after breaking your fast. This will help you adjust your diabetes management plan accordingly. It would be useful if a sugar profile log book is maintained with measurements at pre-Suhoor, two hours after Suhoor, mid-morning 10-11am, 11am to 2pm, pre-Iftar, and two hours after Iftar as well as any time of the day. It is to ensure that measuring blood sugar and taking insulin injections (or other) will not invalidate your fasting.

• Adjust medications: Almost all persons with diabetes are taking one or more of the antihyperglycemic medications. It is difficult for the patients to adjust these and warrants discussing with the physician. They may recommend changes in medication dosage or timing to accommodate fasting hours. 

• Maintaining hydration: All need to drink plenty of water between Iftar (breaking the fast) and Suhoor (pre-dawn meal) to prevent dehydration, especially in hot climates. Avoid sugary drinks and opt for water or sugar-free beverages. The Suhoor meal should contain at least 3% fluid by weight. It would be wise to finish taking Suhoor just before the end time.

• Choosing nutrient-rich foods: During Suhoor and Iftar, choose nutrient-rich foods that provide sustained energy and help regulate blood sugar levels. Include complex carbohydrates, lean proteins, healthy fats, fruits, and vegetables in your meals. Nobody should skip the early night meal (the supper).

• Limiting sugary and high-glycemic foods: Avoid consuming excessive sugary foods and high-glycemic index foods, as they can cause rapid spikes in blood sugar levels. In Bangladesh, people are fond of taking huge carbohydrates during Iftar causing a sharp spike of glycemic surge after Iftar. Opt for healthier alternatives to sweets and desserts.

• Breaking the fast wisely: Start with a small portion of dates and water to break your fast, followed by a balanced meal. Avoid overeating or consuming large portions of high-carbohydrate foods, which can lead to blood sugar spikes.

• Be mindful of physical activity: Limit intense physical activity during fasting hours to avoid fluctuations in blood sugar levels. Engage in light exercise before or after fasting hours, such as walking or gentle stretching. It is advised to avoid any of the moderate to severe physical exercise in the later part of the day. If it is unavoidable, try performing it in the first part of the day, before noon.

• Prioritise rest and sleep: Ensure you get adequate rest and sleep during Ramadan to support overall health and well-being. Lack of sleep can affect blood sugar control and increase the risk of complications.

• Listen to the body: Pay attention to how your body responds to fasting and adjust your routine accordingly. If you experience symptoms such as dizziness, weakness, or severe changes in blood sugar levels, break your fast and seek medical attention if necessary.

By following these tips and closely monitoring your blood sugar levels, you can safely observe fasting during Ramadan while effectively managing diabetes. Remember to prioritise your health and well-being throughout the fasting period.

Dr Shahjada Selim is an associate professor at the Department of Endocrinology of Bangabandhu Sheikh Mujib Medical University.