Managing diabetes during Ramadan

The holy month of Ramadan comes as a blessing for Muslims around the world. While fasting has proven to be physically beneficial for adults of all ages, some risks are always there for people who are suffering from different diseases. Diabetes is one such health condition which can debilitate patients in various ways during Ramadan. Low (hypoglycemia) or high (hyperglycemia) blood glucose levels, diabetic ketoacidosis, dehydration and thromboembolism are some of the issues patients with diabetes may face while fasting.

Diabetic patients should follow these simple rules which will help them prevent the health risks during fasting:

1. Frequently monitor blood glucose levels – at least three times a day, compulsorily once at day end. For type-1 diabetes, blood glucose should be monitored very closely and carefully. The patient should also be extra careful during the early days of Ramadan. 

2. Try to maintain the nutritional value of your daily diet as normal, although that may not be easy. Take the necessary action to maintain normal body weight. Avoid fatty and fried foods in Iftar, since they take time to be digested. A good supply of glucose in the blood of a diabetic patient immediately after iftar is important. Consume carbohydrates that take time to digest at Sehri. In Iftar, easy-to-digest food and plenty of water with other liquids should be consumed.

3. Have Sehri just before the Fajr azan. Also, drink plenty of water at Sehri.

4. Normal physical work or exercise while fasting is advised, but don't do anything in excess. Excessive physical labour may cause hypoglycemia. Hard work should be avoided in the afternoon. Tarawi prayers can also be considered a substitute for physical labour. 

5. Diabetic patients who are fasting should consume glucose/sugar/sweet food, syrup etc, as soon as any hypoglycemia symptom appears. People with hypoglycemia can easily recognise its symptoms early. For those who have not experienced hypoglycemia yet, palpitation (fast beating heart), lightheadedness, sweating, increased heart rate, blurry vision, dizziness, etc, are some of the symptoms. Hypoglycemia occurs when blood glucose is usually 3.3 mmol/L. Also, if the blood glucose drops to 3.9 mmol/L or more within a few hours at the beginning of the day, it is important to eat something.

6. Do not adjust diabetes medications yourself during Ramadan. This can have serious consequences. Consult your physician first. 

7. Drink an adequate amount of water (green coconut water if possible) and eat less sweet fruits and more nutritious foods during the month of Ramadan.

8. Be mindful that medication and diet management will be completely different during Ramadan. When Ramadan is over, you will have to return to your usual diabetic diet and treatment regimen.

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