• International Diabetes Federation: Managing Diabetes During Ramadan

    IDF is the global advocate for people with diabetes and its mission is to promote diabetes care, prevention and a cure worldwide.

    IDF has described diabetes as “one of the largest global health emergencies of the 21st century”. IDF and Diabetes and Ramadan (DAR) International Alliance have come together to deliver comprehensive guidelines to ensure the optimal care for the many patients with diabetes who fast during Ramadan. Here are the key points that we at Mount Lebanon Hospital would like to share with you regarding managing diabetes during Ramadan.

    What is your connection to diabetes?  

    The medical status of diabetics is generally very critical during the month of Ramadan; their health becomes all the more delicate. It is advisable for diabetics to refrain from fasting, especially those that suffer from type II diabetes. Unfortunately, many diabetics still make the decision to fast during the month of Ramadan without consulting a specialist. This may sometimes lead to great complications and prove to be very dangerous to their lives.

    Whether you are suffering from diabetes or know someone who is, here’s a guide on managing diabetes during Ramadan.

    MANAGEMENT

    It is worth reemphasizing that fasting for patients with diabetes represents an important personal decision that should be made after careful consideration of the associated risks with the physician.

     I-Several important issues deserve special attention:

    There is a genuine misconception that pricking the skin for blood glucose testing invalidates the Ramadan fast. Contrary to common belief, checking blood glucose levels is an essential component of diabetes care, and patients should be provided with the tools and knowledge to carry out self-monitoring of blood glucose (should check the blood glucose levels). Here are other issues that diabetic patients that choose to fast should be aware of:

    Individualized Treatment: The most crucial issue is the realization that care must be highly individualized and that the management plan will differ for each specific patient.

    Monitoring the Blood Glucose Levels: It is essential that patients have the means to monitor their blood glucose levels multiple times daily. This is especially critical in patients with type 1 diabetes and in patients with type 2 diabetes who require insulin.

    Meal Planning: The diet during Ramadan should not differ from a healthy and balanced diet. It should aim at maintaining a constant BMI. The common practice of ingesting large amounts of foods rich in carbohydrate and fat, especially at Iftar, should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing “complex” carbohydrates should be limited to Sohoor.  It is also recommended that fluid intake is increased during non-fasting hours and Sohoor be taken as late as possible before the start of the daily fast.

    Physical Activity during Ramadan: Excessive physical activity may lead to higher risk of hypoglycemia especially during the few hours before Iftar. If Taraweeh prayer is performed, then it should be considered a part of the daily exercise program. In some patients with poorly controlled type 1 diabetes, exercise may lead to extreme hypoglycemia. The basic signs of hypoglycemia can be characterized by dizziness, hunger, pounding heart and/or headaches.

    When to break the fast: All patients should understand that they must always and immediately end their fast if hypoglycemia occurs, since there is no guarantee that their blood glucose will not drop further if they wait or delay treatment. The fast should also be broken if blood glucose reaches <70 mg/dl in the first few hours after the start of the fast, especially if insulin are taken at Sohoor. Finally, the fast should be broken if blood glucose exceeds 300 mg/dl.

    II- Pre-Ramadan medical assessment and educational counseling:

    All patients with diabetes who wish to fast during Ramadan should undergo the necessary preparations to undertake the fast as safely as possible. These include medical assessment and educational counseling.

    – Medical assessment: This assessment should take place within 1–2 months before Ramadan. Specific attention should be devoted to the overall well-being of the patient and to the control of their glycemia, blood pressure, and lipids. During this assessment, necessary changes in their diet or medication regimen should be made so that the patient initiates fasting while being on a stable and effective program.

    Educational counseling: It is essential that the patients and family receive the necessary education concerning self-care, including signs and symptoms of hyper and hypoglycemia, blood glucose monitoring, meal planning, physical activity, medication administration, and management of acute complications.

    RISKS ASSOCIATED WITH FASTING IN PATIENTS WITH DIABETES

    Hypoglycemia: Several factors can cause hypoglycemia, low blood sugar levels, in people with diabetes including taking too much insulin or other diabetes medications, skipping a meal, or exercising harder than usual.

    Hyperglycemia: Hyperglycemia, the term for expressing high blood sugar, has been defined by the World Health Organisation as blood glucose levels greater than 126 mg/dl when fasting, blood glucose levels greater than 200 mg/dl 2 hours after meals. Blood sugar levels exceeding 126 mg/dl for extended periods of time can start to cause damage to internal organs.

    Diabetic ketoacidosis: Patients with diabetes, especially those with type 1 diabetes, who fast during Ramadan are at an increased risk for development of diabetic ketoacidosis, particularly if they are grossly hyperglycemic before Ramadan. In addition, the risk for diabetic ketoacidosis may be further increased due to excessive reduction of insulin dosages based on the assumption that food intake is reduced during the month.

    Dehydration and thrombosis: Limitation of fluid intake during the fast is a cause of dehydration. The dehydration may become severe in hot and humid climates and among individuals who perform hard physical labor, all conditions that result in excessive perspiration. In addition, hyperglycemia can result and contribute to electrolyte depletion.

    Fasting during Ramadan has a number of physiological effects. It alters the timings of meals and may disturb sleeping patterns and circadian rhythms all of which can affect a person’s metabolic state. Understanding these changes can help with the management of diabetes during Ramadan.

    Patients who insist on fasting need to be aware of the associated risks and be ready to adhere to the recommendations of their health care providers to achieve a safer fasting experience.

    If you are a diabetic or know a diabetic who is looking to fast in Ramadan and is looking for guidance please contact the Endocrinology and Metabolism Department at Mount Lebanon Hospital.

    05 957000-www.mlh.com.lb

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