MANAGING DIABETES DURING RAMADAN
Fasting for Ramadan:
The Qur’an requires Muslims to fast during the month of Ramadan from sunrise to sunset.
However, there are exceptions to this. One of them is that people who are ill or have medical conditions do not have to fast. This includes people with diabetes. To find out more about this, you can speak to your Imam.
From 2014, for the next several years Ramadan in the UK is in the summer months and the length of fasts is very long (17 hours or more). Long fasts put you at higher risk of hypoglycaemia and dehydration, which can make you ill.
Ultimately, it is a personal choice whether or not to fast. However, if you do choose to fast, then you must consult your doctor or healthcare team before Ramadan, to make sure that you are able to look after yourself properly. Failing to do so is in itself contrary to the Qur’an, which clearly states that you must not act in a way that harms your body.
This information will help you reduce the risks of becoming ill during Ramadan if you decide to fast, as well as highlighting the dangers of fasting for people with diabetes.
If you decide to fast:
- If, after consulting with your doctor, you decide to fast:
- If you are taking insulin, you will require less insulin before the start of the fast
- The type of insulin may also need changing from your usual type
- Pre-mixed insulin is not recommended during fasting
- Before starting the fast, you should include more slowly absorbed food (low GI), such as rice, pitta bread and dhal, in your meal, along with fruit and vegetables
- Check your blood glucose levels more often than you normally would
- When you break the fast, have only small quantities food, and avoid only eating sweet or fatty foods
- Try to eat just before sunrise, when you commence the next day’s fast
- At the end of fasting you should drink plenty of sugar-free and decaffeinated fluids to avoid being dehydrated.
Ramadan & Diabetes – Managing Diabetes During Ramadan
If you are planning on fasting and have diabetes, it is important to speak to your diabetes healthcare team as early as possible before Ramadan. For some people with diabetes, fasting can be dangerous or can cause problems to your health. Your diabetes team will be able to advise you on whether it is safe for you to fast. If you are able to fast, they will advise you on how to keep good diabetes control throughout the fasting period.
WHAT IS DIABETES?
- Diabetes is a health condition where the amount of glucose in your blood gets too high.
- This happens if your pancreas doesn’t make any insulin or enough insulin to help the glucose enter your body’s cells. Or the insulin it does make doesn’t work properly.
- Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it’s used as fuel for energy so we can work, play and generally live our lives. It’s vital for life.
- Glucose come from digesting carbohydrate and it’s also produced by the liver.
- If you have diabetes, your body cannot make proper use of this fuel so it builds up in the blood which can be dangerous.
THERE ARE TWO TYPES OF DIABETES
Type 1 is when the body is unable to produce any
insulin, which we need to break down the glucose
(energy) in what we eat or drink.
- We don’t know exactly what causes it, but we know it’s not to do with being overweight. You can’t prevent Type 1 diabetes.
- It is usually diagnosed when you are a child or young adult.
- Approximately 10 per cent of people with diabetes have Type 1.
Type 2 develops when the body cannot make enough insulin, or when the insulin produced doesn’t work properly.
- Your family history, age and ethnic background affects your risk of developing it, and you’re more likely to get Type 2 diabetes if you’re overweight.
- It starts gradually, usually later in life, and because the symptoms may not be so obvious it might be years before you learn that you have it.
- If undetected, can lead to serious life-threatening conditions.
- Approximately 90 per cent of people living with diabetes have Type 2.
WHAT HAPPENS TO MY BODY WHEN I FAST?
When we don’t eat during a fast, at about eight hours after our last meal our bodies start to use energy stores to keep our blood glucose (sugar) levels normal. For most people, this is not harmful.
With diabetes, especially if you take certain tablets
or insulin, you are at risk of hypoglycaemia or ‘hypos’ (low blood glucose levels). This year, the fasts are long and the risks of hypoglycaemia and dehydration (lack of water) are high. Another problem that can occur if you have diabetes, is the risk of high glucose levels following the larger meals that we eat before and after fasting (at Suhoor/Sehri and Iftar).
Hypoglycaemia, high glucose levels and dehydration
can be dangerous for people with diabetes
I HAVE DIABETES – CAN I FAST?
Most people with health problems, such as diabetes
are exempt from fasting. Choosing to fast is a personal decision that you should make with advice from your diabetes team. For some people with diabetes, fasting can be dangerous or cause problems to your health. Speak to your GP, diabetes nurse or diabetes doctor before fasting.
Certain people and circumstances are exempt from
fasting. For example:
- children (under the age of puberty)
- the elderly
- those who are sick or have a certain health condition
- those with learning difficulties
- those who are travelling
- pregnant, breastfeeding and menstruating women
- anyone who would be putting their health at serious risk by fasting, eg people who treat their diabetes with insulin and/or certain medication, people who have diabetic complications (damage to eyes, kidney or the nerves in your hands and feet), or people who have poor control of their diabetes.
Remember, if you cannot fast, you can complete
your duties by offering charity or providing food to the poor. Speak to your local Imam for more information about this.
Remember, if you cannot fast this Ramadan, you may be able to make up the fast at a later date, perhaps during the winter months.
You must speak to your doctor or diabetes nurse
about your diabetes treatment as early as possible
IS IT OK TO TEST MY BLOOD GLUCOSE IN RAMADAN WHILE I AM FASTING?
Yes, testing your blood glucose levels regularly is important and will keep you safe while fasting. This will not break your fast.
DO I NEED TO WAKE UP FOR SUHOOR (SEHRI)?
Long hours without eating increase the risk of hypoglycaemia. You must try to eat a meal at Suhoor just before sunrise and not at midnight, as this will help to keep your glucose levels more balanced through the fast.
WHAT TYPES OF FOOD SHOULD I EAT AT SUHOOR (SEHRI)?
At Suhoor you should eat starchy carbohydrates which release energy slowly, such as multigrain bread, oat-based cereals, basmati rice together with beans, pulses, lentils and fruit and vegetables. Other foods which will keep your blood glucose levels more stable through the fast include pitta bread, chapattis and semolina. As with all meals, eat sensibly, do not over eat and remember to drink plenty of water.
WHAT TYPES OF FOOD SHOULD I EAT AT IFTAR?
Remember to eat sensibly and healthily all year round but also in Ramadan. Overeating and eating the wrong foods (such as fried foods, foods high in fat and sugar) in large quantities will not only make you put on weight but will also lead to big increases and imbalances in your blood glucose levels. Keep portion sizes moderate. Remember that Ramadan is also about self-control and discipline. Please see your dietitian for further advice.
WHAT TYPES OF DRINKS CAN I HAVE?
Fasting can put you at risk of dehydration with long
hours of fasting and also if you have high blood glucose levels. Drink plenty of fluids (sugar-free), particularly water at Suhoor and after Iftar.
CAN I PRAY TARAWEEH?
Remember, Taraweeh can be a strenuous activity and you could become dehydrated or have low blood glucose levels.
To avoid problems during Taraweeh, make sure you:
- eat starchy foods with Iftar as they are digested slowly
- drink plenty of water following Iftar
- take a bottle of water and glucose treatment with you to Taraweeh.
Always carry glucose treatment with you.
- Always have diabetes identification, such as a medical bracelet.
- Test your blood regularly to monitor your glucose (sugar) levels. This will not break your fast.
- Test your blood glucose level if you feel unwell during the fast.
- If your blood sugar level is high or low, you must treat this.
- If your blood glucose is less than 3.3mmol/l, end the fast immediately and treat the low blood sugar level.
- If your blood glucose level is 3.9mmol/l at the start of the fast and you are on insulin or gliclazide, do not fast.
- If your blood glucose level is higher than 16mmol/l, end the fast immediately.
- If you become dehydrated, end the fast immediately and have a drink of water.
- If you start to feel unwell, disoriented, confused, if you collapse or faint, stop fasting and have a drink of water or other fluid.
- You should never stop your insulin, but you must speak to your doctor because you may need to change the dose and times of your insulin injections.
IS RAMADAN A GOOD TIME TO GIVE UP SMOKING?
If you have diabetes, smoking increases your risk of heart problems. Ramadan is a good time to build up your self-control and give up smoking. Talk to your GP if you are interested.
- Speak to your diabetes team if you are planning to fast.
- Check your blood glucose levels more often.
- Try to fast a couple of days in the month before Ramadan (the month of Shabaan) to see if you are capable of fasting without complications.
- Continue a varied and balanced diet.
- Include more starchy carbohydrates and slowly absorbed foods.
- Try not to have too many sugary and fatty foods.
- When you break the fast, ensure you drink plenty of sugar-free and decaffeinated drinks to avoid dehydration.
Courtesy: Written by the Muslim Council of Britain Diabetes Advisory Group (Dr Sarah Ali, Dr Sufyan Hussain, Dr Tahseen Chowdhury, Professor Wasim Hanif and Dr Shuja Shafi) and Diabetes UK.