Diabetes and Ramadan Fasting
Physicians face the difficult task of advising their Muslim diabetic patients whether it is safe to fast, as well as recommending the dietary and drug regimens diabetics should follow. The lack of adequate literature on this subject makes it more difficult to answer these questions.
If you are a physician, read this review article intended is to assist physicians who face the difficult task of advising diabetic patients about the safety of fasting during the Islamic month of Ramadan. There have been diverse findings regarding the physiological impact of Ramadan on diabetics. However, researchers have not found pathological changes or clinical complications in any of the following parameters in diabetics who fast: body weight, blood glucose, HbA1C, c-peptide, insulin, fructoseamine, cholesterol and triglycerides.
If you are a patient, first you should understand the basics of normal diet for pateints of diabetes (click here to read) .
As per the opinion of doctors and findings in the famous research by Dr Fereidoun Azizi, MD, and Dr Behnam Siahkolah, MD Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, I.R. Iran, guidelines are given below.
Recommendations during ramadan fasting
· Dry or sticky mouth
· Low or no urine output; concentrated urine appears dark yellow
· Sunken eyes
· Lethargic condition, feeling of great tiredness
Remember to follow the 3Ds-
1) Drug regimen adjustment
2) Diet control
3) Daily activity
For people with NIDDM (non insulin dependant) or type 2 diabetes:
If you are a NIDDM patient, you can fast after evaluating yourself based on this information:
1) Sahur (diet before dawn) should be equal to a full meal.
2) don’t fast on the day when you skip ‘sahur’ (diet before dawn)
3) Drug regimens for NIDDM patients:
Available reports indicate that there are no major problems encountered with NIDDM overweight patients who observe fasting in Ramadan. With proper changes in the dosage of hypoglycemic agents there will be low risk for hypoglycemia and hyperglycemia. It is recommended that diabetics switch the morning dose (together with any mid-day dose) of this drug with the dosage taken at sunset.
For people with IDDM (insulin dependant) or type 1 diabetes:
If you are a IDDM patient, you SHOULD NOT fast. However If you decide to fast, follow this advice:
Drug regimens for IDDM patients:
Some experienced physicians conclude Ramadan fasting is safe for IDDM patients with proper self-monitoring and close professional supervision (16). It is fundamental to adjust the insulin regimen for good IDDM control during Ramadan fasting. Two insulin therapy methods have been studied successfully
1. Three-dose insulin regimen: two doses before meals (sunset and Dawn) of short-acting insulin and one dose in the late evening of intermediate-acting insulin (16)
2. Two-dose insulin regimen: Evening insulin combined with short-acting and medium-acting insulin equivalent to the previous morning dosage, and a pre-dawn insulin consisting only of a regular dosage of 0.1-0.2 unit/kg (25).
Fasting should not be done in these cases:
Brittle diabetes, also called labile diabetes, is a term used to describe uncontrolled type 1 diabetes. People with brittle diabetes frequently experience large swings in blood sugar (glucose) levels. These cause either hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), which is more common and sometimes extreme.
You may also read:
Medication and diet Advice to the Diabetic Patient who wants to FAST during the Holy month of Ramadan: By: Dr M Akber, Consultant Physician in Diabetes & Endocrinology
University Hospital of North Staffordshire, Stoke on Trent, UK
Ramadan and diabetes from diabetes.co.uk a global diabetes community in UK
Detailed guide on diet during ramadan fasting for non diabetics as well as diabetics
mail me at khalid2277@rediffmail.com
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