Fasting is often a religious ritual recommended by almost every major religion of the world.Ramadan, the ninth month of Islamic lunarHijri calendar, is marked by the religiousritual of As-Saum (the fasting), which is one of the five Pillars of Islam. Fasting starts from early dawn (Suhur /Sehn) till sunset (/{tar). Over a billion people across the globe practice fasting during Ramadan.The start of Ramadan advances by 11 days every year as it is based on a lunar calendar. It may sometimes fall in the summer months, resulting in a more onerous fast than when it falls in the winter months. For the next several years Ramadan in India would be observed in the summer months. The duration of the fasts is very long and lasts up to 17+ hours.During this period one has to abstain from eating or drinking. This ritual is compulsory for all mature followers of Islam but exemptions are there to accommodate individuals who cannot fast for various reasons.Diabetes and fastingDiabetes is a chronic disease and as per recent estimates the number of people affected by Diabetes worldwide is about 537 million. This number is increasing at an alarming rate across the world. More than 60 million people with Diabetes fast during Ramadan. If people with Diabetes intend to fast during the holy month, they need to take precautions and require being cared for differently.While one desires to take up the fast, there are several questions that can arise with regards to this tradition, such as- who are the people with Diabetes who can fast?Who shouldn't? If one fasts what are the precautions to be taken? What about the type and dose of medications during the holy month - does there need to be any modification? Are there any special dietary recommendations during the holy month?Physical effects of fastingAfter about eight hours of fasting, our body starts using stored glucose to keep our blood glucose levels normal. Later on, it relies on fat as a source of energy. For most people, this is not harmful. But people withDiabetes, especially if they are prescribedmedication or insulin, may have a risk of hypoglycaemia (low blood sugar levels). This year, the fasts are long and the risks of hypoglycaemia and dehydration (lack of water) are high.Symptoms of hypoglycaemia include shaking, sweating, blurred vision, tingling of the lips, hunger, irritability (or anxiety), confusion, dizziness, drowsiness, fast pulse (or palpitations). Symptoms of dehydration include thirst, reduced urination, drymouth, lips and skin. Dehydration increases the risk of thrombosis or clotting of bloodin the vessel. Symptoms may include pain, swelling and redness at the site of thrombosis or severing pain in the affected legs, prominent veins that stick out from the skin and an itchy, skin rash or warm skin.Additionally, there is a risk of high glucos levels following the larger meals that are eight hours of eaten before and after fasting (at Suhoor/Sehri and /{tar). Symptoms of blood sugar level spikes include weight loss,fatigue, thirst, increased urination, headaches, extreme tiredness, ketones in urine (pear drop smell on breath) and loss of concentration. Testing blood sugar levels regularly is important for people with Diabetes during the fasting. Testing blood sugar levels will not break the fast. Light to moderate exercise is recommended during this holy month of fasting. Rigorous exercise may put people with Diabetes at an increased risk of hypoglycaemia.Exempted from fasting Most people with health problems such as Diabetes are exempt from fasting. Choosing to fast is a personal decision that one should make after seeking advice from theirDiabetes healthcare team. For some people with Diabetes, fasting can be dangerous and may cause health problems. Certain people and circumstances are exempt from fasting such as:• children (under the age of puberty)• the elderly• those who are sick or have a certain health condition or those who are grossly incapacitated• those with learning difficulties• travellers• menstruating, pregnant, breastfeedingand post-delivery women• Anyone who would be putting their health at a serious risk by fasting, like people who have Diabetes and are taking insulin and/or medications, people who have complications(damage to eyes, kidney or the nerves in hands or feet) or people who have poor control of their Diabetes or people with Diabetes who experience severe hypoglycaemia or have a history of recurrent hypoglycaemia.Try to fast a couple of days in the month before Ramadan (the month of Sh.abaan) to see if you are capable of fasting without complications. If one cannot fast, he or she may complete their duties by offeringcharity or providing food to the poor. Speak to your local Imam for more information about this. If you cannot fast thisRamadan, you may be able to make up the fast at a later date, perhaps during the winter months. You must speak to your endocrinologist and diabetologist about Diabetes management before beginning your Ramadan fasting.Suhoor (Sehri/ meal before dawn)Long hours without eating can 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 blood sugar levels more balanced throughout the fast.Permitted foods at SuhoorAt Suhoor you can eat starchy carbohydrates and slowly absorbed foods which release energy slowly, such as multigrain bread, oat-based cereals, .basmati rice accompanied by beans, pulses, lentils, porridge and fruit and vegetables. Fibre-rich foods can also help as they are digested slowly. These include bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruits.Other foods which will keep your blood sugar levels more stable through the fast include bread, chapattis, barley, oats, grains, a handful of nuts and dates, yoghurt, steam-cooked boiled vegetables etc. Consume a varied and balanced diet. Try not to have too many sugary and fatty foods such asparathas, purls, pakodas and samosas. As with all meals, eat sensibly, do not over eat and remember to drink plenty of water. Home cooked food should be preferred over restaurant foods.Permitted foods at lftar {meal after sunset)Remember to eat sensibly and healthily during Ramadan too. 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 blood sugarlevel spikes. Instead of heavy sehri or iftaar, it is better to have several small nutritious meals after breaking the fast. Keep portion sizes moderate. Remember that Ramadan is also about self-control and discipline.Consult your dietician on how to fast healthy without affecting your blood sugar levels.Fasting can put you at risk of dehydration, with long hours of not eating and drinking and also if you have high blood sugar levels. Drink plenty of sugar-free fluids, inparticular, water at Suhoor and after /{tar. When you break the fast, ensure you drink plenty of sugar-free and decaffeinated drinks, fruit juices to avoid dehydration.Praying TaraweehTaraweeh refers to extra prayers performed by Sunni Muslims at night in the Islamic month of Ramadan. Many Muslims offer these prayers in the night during Ramadan. Remember, Taraweeh can be a strenuous activity and you could become dehydrated or experience low blood sugar levels.To avoid problems during Taraweeh, make sure you:• eat starchy foods with /{tar as they are digested slowly,• drink plenty of water following /{tar and• take a bottle of water and glucose treatment with you to Taraweeh .Remember to:• Always carry your blood sugar monitoring kit with you.• Always wear Diabetes identification such as a medical bracelet.• Monitor your blood sugar levels by testing regularly.• Test your blood sugar level if you feel unwell during the fast.• If your blood sugar levels are high or low, you must treat this.• If your blood glucose is less than 60 mg/dL, end the fast immediately and treat the low blood sugar levels.• If your blood sugar level is below 70 mg/dL in the first few hours of fasting and you are on insulin or sulphonylureas (or any other medication that can cause hypoglycaemia), do not continue the fast.• If your blood sugar level is higher than 300 mg/dL, end the fast immediately.• If you become dehydrated, end the fast immediately and drink water.• If you start to feel unwell, disoriented, confused, if you collapse or faint, stop fasting and drink 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 time of your insulin injections.• 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.It is important to seek immediate medical help if any of the above mentioned problems occur. It is of paramount importance to speak with your Diabetes healthcare team before resuming your fast. Seeking timely medical advice and intervention will help you better manage your Diabetes and help you fast with greater success. Note: It is of utmost importance to consult your doctor and dietician before you change your diet. People with Diabetes should only fast after seeking medical advice.
Fasting is often a religious ritual recommended by almost every major religion of the world.Ramadan, the ninth month of Islamic lunarHijri calendar, is marked by the religiousritual of As-Saum (the fasting), which is one of the five Pillars of Islam. Fasting starts from early dawn (Suhur /Sehn) till sunset (/{tar). Over a billion people across the globe practice fasting during Ramadan.The start of Ramadan advances by 11 days every year as it is based on a lunar calendar. It may sometimes fall in the summer months, resulting in a more onerous fast than when it falls in the winter months. For the next several years Ramadan in India would be observed in the summer months. The duration of the fasts is very long and lasts up to 17+ hours.During this period one has to abstain from eating or drinking. This ritual is compulsory for all mature followers of Islam but exemptions are there to accommodate individuals who cannot fast for various reasons.Diabetes and fastingDiabetes is a chronic disease and as per recent estimates the number of people affected by Diabetes worldwide is about 537 million. This number is increasing at an alarming rate across the world. More than 60 million people with Diabetes fast during Ramadan. If people with Diabetes intend to fast during the holy month, they need to take precautions and require being cared for differently.While one desires to take up the fast, there are several questions that can arise with regards to this tradition, such as- who are the people with Diabetes who can fast?Who shouldn't? If one fasts what are the precautions to be taken? What about the type and dose of medications during the holy month - does there need to be any modification? Are there any special dietary recommendations during the holy month?Physical effects of fastingAfter about eight hours of fasting, our body starts using stored glucose to keep our blood glucose levels normal. Later on, it relies on fat as a source of energy. For most people, this is not harmful. But people withDiabetes, especially if they are prescribedmedication or insulin, may have a risk of hypoglycaemia (low blood sugar levels). This year, the fasts are long and the risks of hypoglycaemia and dehydration (lack of water) are high.Symptoms of hypoglycaemia include shaking, sweating, blurred vision, tingling of the lips, hunger, irritability (or anxiety), confusion, dizziness, drowsiness, fast pulse (or palpitations). Symptoms of dehydration include thirst, reduced urination, drymouth, lips and skin. Dehydration increases the risk of thrombosis or clotting of bloodin the vessel. Symptoms may include pain, swelling and redness at the site of thrombosis or severing pain in the affected legs, prominent veins that stick out from the skin and an itchy, skin rash or warm skin.Additionally, there is a risk of high glucos levels following the larger meals that are eight hours of eaten before and after fasting (at Suhoor/Sehri and /{tar). Symptoms of blood sugar level spikes include weight loss,fatigue, thirst, increased urination, headaches, extreme tiredness, ketones in urine (pear drop smell on breath) and loss of concentration. Testing blood sugar levels regularly is important for people with Diabetes during the fasting. Testing blood sugar levels will not break the fast. Light to moderate exercise is recommended during this holy month of fasting. Rigorous exercise may put people with Diabetes at an increased risk of hypoglycaemia.Exempted from fasting Most people with health problems such as Diabetes are exempt from fasting. Choosing to fast is a personal decision that one should make after seeking advice from theirDiabetes healthcare team. For some people with Diabetes, fasting can be dangerous and may cause health problems. Certain people and circumstances are exempt from fasting such as:• children (under the age of puberty)• the elderly• those who are sick or have a certain health condition or those who are grossly incapacitated• those with learning difficulties• travellers• menstruating, pregnant, breastfeedingand post-delivery women• Anyone who would be putting their health at a serious risk by fasting, like people who have Diabetes and are taking insulin and/or medications, people who have complications(damage to eyes, kidney or the nerves in hands or feet) or people who have poor control of their Diabetes or people with Diabetes who experience severe hypoglycaemia or have a history of recurrent hypoglycaemia.Try to fast a couple of days in the month before Ramadan (the month of Sh.abaan) to see if you are capable of fasting without complications. If one cannot fast, he or she may complete their duties by offeringcharity or providing food to the poor. Speak to your local Imam for more information about this. If you cannot fast thisRamadan, you may be able to make up the fast at a later date, perhaps during the winter months. You must speak to your endocrinologist and diabetologist about Diabetes management before beginning your Ramadan fasting.Suhoor (Sehri/ meal before dawn)Long hours without eating can 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 blood sugar levels more balanced throughout the fast.Permitted foods at SuhoorAt Suhoor you can eat starchy carbohydrates and slowly absorbed foods which release energy slowly, such as multigrain bread, oat-based cereals, .basmati rice accompanied by beans, pulses, lentils, porridge and fruit and vegetables. Fibre-rich foods can also help as they are digested slowly. These include bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruits.Other foods which will keep your blood sugar levels more stable through the fast include bread, chapattis, barley, oats, grains, a handful of nuts and dates, yoghurt, steam-cooked boiled vegetables etc. Consume a varied and balanced diet. Try not to have too many sugary and fatty foods such asparathas, purls, pakodas and samosas. As with all meals, eat sensibly, do not over eat and remember to drink plenty of water. Home cooked food should be preferred over restaurant foods.Permitted foods at lftar {meal after sunset)Remember to eat sensibly and healthily during Ramadan too. 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 blood sugarlevel spikes. Instead of heavy sehri or iftaar, it is better to have several small nutritious meals after breaking the fast. Keep portion sizes moderate. Remember that Ramadan is also about self-control and discipline.Consult your dietician on how to fast healthy without affecting your blood sugar levels.Fasting can put you at risk of dehydration, with long hours of not eating and drinking and also if you have high blood sugar levels. Drink plenty of sugar-free fluids, inparticular, water at Suhoor and after /{tar. When you break the fast, ensure you drink plenty of sugar-free and decaffeinated drinks, fruit juices to avoid dehydration.Praying TaraweehTaraweeh refers to extra prayers performed by Sunni Muslims at night in the Islamic month of Ramadan. Many Muslims offer these prayers in the night during Ramadan. Remember, Taraweeh can be a strenuous activity and you could become dehydrated or experience low blood sugar levels.To avoid problems during Taraweeh, make sure you:• eat starchy foods with /{tar as they are digested slowly,• drink plenty of water following /{tar and• take a bottle of water and glucose treatment with you to Taraweeh .Remember to:• Always carry your blood sugar monitoring kit with you.• Always wear Diabetes identification such as a medical bracelet.• Monitor your blood sugar levels by testing regularly.• Test your blood sugar level if you feel unwell during the fast.• If your blood sugar levels are high or low, you must treat this.• If your blood glucose is less than 60 mg/dL, end the fast immediately and treat the low blood sugar levels.• If your blood sugar level is below 70 mg/dL in the first few hours of fasting and you are on insulin or sulphonylureas (or any other medication that can cause hypoglycaemia), do not continue the fast.• If your blood sugar level is higher than 300 mg/dL, end the fast immediately.• If you become dehydrated, end the fast immediately and drink water.• If you start to feel unwell, disoriented, confused, if you collapse or faint, stop fasting and drink 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 time of your insulin injections.• 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.It is important to seek immediate medical help if any of the above mentioned problems occur. It is of paramount importance to speak with your Diabetes healthcare team before resuming your fast. Seeking timely medical advice and intervention will help you better manage your Diabetes and help you fast with greater success. Note: It is of utmost importance to consult your doctor and dietician before you change your diet. People with Diabetes should only fast after seeking medical advice.
