Diabetes and Ramadan: managing your blood glucose while fasting
40 to 50 million people with diabetes worldwide fast during Ramadan, the ninth month of the Islamic calendar [1,2]. Fasting between sunrise and sunset may raise the risk of hypoglycaemia and hyperglycaemia [2]. Read on for an overview of some tips for managing diabetes during fasting.
Adjust your treatment in consultation with your doctor
Consider getting in touch with your healthcare professional and let them know of your intention to fast. This will provide you with a professional opinion about the risks involved with fasting in your particular case - depending on your specific medical context you may be advised not to - and information about possible consequences and the best way of avoiding them.
Observing the holy month while managing your diabetes is possible and they will be able to help you to adapt your diet, physical activity, and treatment to the special conditions of Ramadan [1,2,3]. The recommendations given by your healthcare professional will be personalised in relation to your diabetes and your medical profile [2].
Type 1 Diabetes
If you’re living with type 1 diabetes, to better manage your blood glucose levels while fasting, you may generally not only be encouraged to change the times of day and doses administered, but perhaps also the type of insulin. It is recommended that you pay particular attention to increasing your frequency of blood glucose testing [2,3].
Type 2 Diabetes
With type 2 diabetes, you will probably be advised, on the one hand, to spread your calorie intake over three meals throughout the non fasting intervals to split food quantities into smaller amounts and limit episodes of hyperglycaemia, and to adjust the length and intensity of physical activity during the day to limit the risks of hypoglycaemia, on the other hand [2].
What if your diabetes treatment includes medication?
If your diabetes treatment includes medication, changes may also be recommended: when possible, preference should be given to types of medication that are not likely to trigger hypoglycaemia (Metformin, Glitazones, dipeptidyl peptidase-4, inhibitors...), perhaps also changing the times of day at which they are taken. [1,2]. Lastly, if you are taking insulin, you may need to change the amount and frequency of dosage [2,4].
Your diet during fasting
Ramadan is a moment for spending time with family and friends and eating traditional dishes, so here are some dietary tips to help you enjoy these moments to the full while managing your diabetes:
- consider spreading your food intake over two or three small meals to limit hyperglycaemia [1,2];
- try to maintain a balanced food intake throughout the month of Ramadan by limiting the consumption of large quantities of sweet and fatty foods [1,2];
- include small amounts of simple sugars (for example a few dates) in your evening iftar meal and opt for the more complex carbohydrates in your pre-dawn seher meal [1,2,3];
- consider including high-fibre foods (wholegrain cereals, brown rice, fruit and vegetables) for the iftar and seher meals [1];
- have your pre-dawn seher meal as late as possible [2].
As one of the five pillars of Islam, Ramadan is an important time for all Muslims. Consulting with your healthcare professional and adjusting your treatment will enable you to experience this sacred time comfortably.
References
- A. Badshah. Management of diabetes in Ramadan. J Ayub Med Coll Abbottabad Oct-Dec 2018; 30(4), 596-602.
- M. Al-Arouj et al. Recommendations for Management of Diabetes During Ramadan. Diabetes Care 2005 Sep; 28(9): 2305-2311; doi: 10,2337/diacare.28.9.2305. https://doi.org/10.2337/diacare.28.9.2305.
- M. H. Ahmed, Diabetes and Ramadan: A concise and practical update. J Family Med Prim Care. 2017 Jan-Mar;6(1):11–18; doi: 10.4103/2249-4863.214964.
- M. Hassanein et al. Diabetes and Ramadan: Practical guidelines. Diabetes Research and clinical practices Vol. 126 (March 2017) 303-316; doi: 10.1016/j.diabres.2017.03.003
