It was around 4:00 p.m. when Shilpa, a dedicated Diabetes educator, received a call from the helpdesk. She was informed about a visitor and kindly asked them to send the guest to her office. A few moments later, a poised and smart-looking young woman, about 30 years old, entered the room.Aarti: Good evening, Ms. Shilpa. My name is Aarti.Shilpa: Good evening, Ms. Aarti! Please have a seat. How can I assist you today?Aarti: I work as a counselor and coordinator at an old age home. Our residents come from diverse cultural and religious backgrounds, and many of them have Diabetes. Recently, I've noticed that some residents experience health complications when they fast for religious or social reasons. I would like to learn more about how fasting affects individuals with Diabetes and whether it can be done safely. Could you guide me?Shilpa: That's an excellent and thoughtful question, Ms. Aarti. Fasting can indeed pose challenges for individuals with Diabetes, but it's possible to approach it safely with proper planning and care.From a medical perspective, fasting is generally not recommended because of the potential risks, especially for those with fluctuating blood glucose levels. However, for individuals with well-controlled Diabetes (managed through diet and exercise alone) fasting can be considered safe if done cautiously.For others, especially those on medication or insulin, fasting requires extra care. If someone with Diabetes is determined to fast, they should consult their healthcare provider to create a tailored plan. This includes monitoring blood glucose levels, adjusting medications if necessary, and staying hydrated. With the right guidance and precautions, fasting can sometimes be accommodated while minimizing risks.Aarti: Precautions? Could you explain that further?Shilpa: Of course! Before fasting, it's crucial for anyone with Diabetesyoung, adult, or elderlyto consult their doctor. A complete Diabetes checkup is highly recommended to ensure there are no underlying complications. If any issues are identified, it's safer to avoid fasting to prevent health risks.Aarti: Could you help me understand what happens to the body when someone fasts?Shilpa: Certainly. Insulin plays a vital role in the body. Its primary function is to regulate blood glucose levels. It helps transport excess glucose from the blood into muscles and the liver, where it is stored as glycogen to maintain stable blood glucose levels. Insulin also supports fat synthesis, reducing free fatty acids in the blood.During fasting, in healthy individuals, when meals are skipped, blood glucose levels naturally decrease, and insulin production adjusts accordingly. The body compensates by using stored glucose from the liver and muscles, in the form of glycogen, to maintain energy levels. Counter-regulatory hormones help in this process, ensuring the brain and red blood cells (both of which rely on glucose) continue functioning properly.When glucose availability reduces further, the body switches to using stored fats as an energy source. This process produces ketones, which are used as fuel by skeletal muscles, the heart, and other tissues. Fasting triggers, a complex metabolic response, but in healthy individuals, the body adapts effectively to maintain balance.Aarti: What happens when a person with Diabetes fasts?Shilpa: When someone with Diabetes fasts, several challenges arise because their body doesn't produce enough insulin or, in some cases, any insulin at all.Insulin is essential for the body's normal functioning, and Diabetes is usually managed with medications or insulin therapy.Unfortunately, some people with Diabetes mistakenly believe they don't need insulin or their medications while fasting. However, the body continues to produce glucose from stored sources in the liver and muscles because the brain and red blood cells depend on glucose to function. Without insulin or medication, this glucose cannot be stored back in the liver or muscles, leading to a rapid increase in blood glucose levels due to the action of counter- regulatory hormones.Additionally, insulin helps in fat synthesis. When insulin is absent or insufficient, fat synthesis halts, and the level of free fatty acids in the blood increases. The body then begins breaking down stored fats for energy, producing ketones as a byproduct. In people with Diabetes, this process can go unchecked, leading to an excessive buildup of ketones in the blood, causing a condition called ketosis.As ketone levels rise, the blood becomes more acidica condition known as diabetic ketoacidosis (DKA). This is extremely dangerous and often requires immediate medical attention, including admission to an ICU. While DKA is more common in people with Type 1 Diabetes, in rare cases, individuals with Type 2 Diabetes can also develop it. That's why it's crucial for anyone with Diabetes to consult their healthcare provider before fasting to ensure they stay safe.Aarti: So it's very important for persons to discuss their condition with their doctor before fasting!Shilpa: Absolutely! Consulting a doctor is essential because they can adjust the medications and their timing based on the type of fasting. For instance, somepeoplefastfor24hourswithonlywater,while others fast from dawn to dusk, abstaining from both food and water. Each type of fasting requires a tailored approach. If the person is on insulin, the doctor may need to modify the doses to match the changed meal pattern. In some cases, the type of insulin may also need to be switched, as different insulins work in different ways.Additionally, it's crucial to reduce physical activity during fasting to prevent hypoglycaemia, which is a drop in blood glucose levels. Prolonged fasting, such as going without food for 24 hours or more, is strongly discouraged for individuals with Diabetes due to the significant risks involved.Aarti: Why should the medications be changed or modified? Sugars are produced from the liver and muscles during fasting, right?Shilpa: That's correct, but certain medications, like sulphonylureas and insulin, can cause hypoglycemia if meals are skipped or reduced. Hypoglycemia occurs when blood glucose levels drop too low, leading to symptoms such as sweating, trembling, palpitations, headaches, and intense hunger. If these symptoms appear, it's crucial for the person to break their fast immediately to avoid severe complications.To prevent such situations, it's important to consult a doctor before fasting. They can adjust your medications, switching to those that are less likely to cause hypoglycemia. Similarly, insulin doses need to be carefully modified to align with the fasting schedule. This ensures a safer fasting experience while minimising risks.Aarti: Are there any other risks besides low blood glucose?Shilpa: Yes, there are. If someone skips their medications or insulin, their blood glucose levels can get very high, which can lead to a serious condition called diabetic ketoacidosis (DKA). This is more common in people with Type 1 Diabetes and can be life-threatening.If the fasting also includes not drinking water, it can cause dehydration. When the body loses too much water, it affects how everything works. The blood can become thicker, which makes it easier for clots to form. These clots can block blood flow and increase the risk of serious problems like heart attacks or strokes. That's why it's so important to talk to a doctor before fasting to avoid these risks.Aarti: Oh! I had the misconception that a person could completely stop taking insulin or other medications while fasting since they're skipping meals.Shilpa: That's a common myth, Ms. Aarti. Many persons believe the same, and it often leads to complications. The truth is, skipping insulin or medication under the assumption that they aren't needed can cause blood glucose levels to rise significantly, resulting in severe hyperglycemia that may require hospitalisation. On the other hand, some persons overeat or consume high-sugar foods after fasting all day, thinking it will make up for the missed meals. This too can cause a dangerous spike in blood glucose levels.The risks of complications from fasting vary from person to person. Those who manage their Diabetes with diet and exercise alone, or use medications like metformin, acarbose, or incretin-based therapies, are generally at a lower risk of complications provided the dosage and timings of their medications are adjusted appropriately.Aarti: Who are considered high-risk persons?Shilpa: High-risk persons include:• Those with an HbA1c level (three-month average blood glucose) greater than 7.5 per cent.• People with kidney disease, heart problems, or a history of stroke.• Individuals living alone and taking medications like sulphonylureas or insulin.• Elderly adults in poor health.• Persons on psychiatric medications.• Anyone who has had severe or repeated low blood glucose (hypoglycemia) or diabetic ketoacidosis in the three months before fasting.• Those with hypoglycemia unawareness, meaning they don't feel the usual symptoms of low blood glucose.• Pregnant women with Diabetes.These individuals face a higher risk of complications while fasting and should always consult their doctor before attempting it.Aarti: So, it's always advisable for people with Diabetes who are at a higher risk to avoid fasting, right?Shilpa: That's correct. For high-risk individuals, fasting is generally not recommended due to the serious health complications it can cause. However, if a person still wishes to fast, it requires careful planning and close monitoring.First and foremost, they should consult their doctor to determine if they are fit to fast. Regular monitoring of blood glucose is essential. Using a continuous glucose monitoring (CGM) system is ideal as it provides real-time data and helps identify trends in blood glucose levels..If hypoglycemia occurs during fasting, they should break the fast immediately by consuming 15 grams of glucose or sugar (about 3 teaspoons) and recheck their sugar levels after 15 minutes. If symptoms persist, they should seek medical care without delay. Similarly, fasting must be stopped if blood glucose levels exceed 300 mg/dL or if symptoms of hyperglycemia arise.It's also essential to reduce strenuous physical activity during fasting hours to prevent low blood glucose. Light activity or exercise can be done after breaking the fast. Working with a dietician to create a tailored meal plan is critical, as calorie and nutrient needs vary for each individual.Under the updated guidelines, it's also advised to prepare for fasting by monitoring blood glucose trends for at least two weeks beforehand.Adjustments to medication and insulin doses must be made by the healthcare team based on the fasting schedule, whether it involves complete abstinence from food and water or only food restrictions. Following these steps can help reduce risks, but fasting should always be approached cautiously and under medical supervision for individuals with Diabetes.Aarti: What is continuous glucose monitoring?Shilpa: Continuous glucose monitoring, or CGM, is a technology that uses a small sensor placed under the skin to measure glucose levels in real-time. The sensor checks glucose levels every few minutes and sends the data wirelessly to a receiver, smartphone.Modern CGM devices provide detailed insights by tracking glucose trends throughout the day and night. They not only show current glucose levels but also provide arrows to indicate whether glucose is rising, falling, or stable. This allows persons and doctors to spot patterns, such as sudden spikes or drops, and make informed decisions about treatment, diet, and activity.Some CGM systems also send alerts when glucose levels go too high or too low, even while the person is sleeping. The data can be shared remotely with healthcare providers or family members, making it easier to manage Diabetes more proactively.The information from CGMs helps doctors make precise adjustments to medications or insulin doses and tailor the treatment plan to the individual's needs. It's a game-changer in Diabetes management, providing both convenience and better control over blood glucose levels.Aarti: That's really great. This can help prevent complications to some extent.Shilpa: Yes, continuous glucose monitoring provides a clear picture of how blood glucose levels fluctuate throughout the day, which helps individuals with Diabetes better manage their blood glucose. It's also important for caregivers, family members, and friends to be aware of the symptoms of hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), so they can recognize them early and assist the person if needed.This is particularly crucial for preventing situations like hypoglycemia unawareness, where the person with Diabetes may not feel the symptoms themselves. Caregivers should know how to check blood glucose levels, what to do in case of hypoglycemia, and how to handle any emergencies that may arise.It's also vital that persons and their caregivers are counseled on when to break the fast. If someone with Diabetes fasting feels unwell or experiences any unusual symptoms, they should stop fasting immediately. I hope I've been able to address your questions, Ms. Aarti.Aarti: Thank you so much for your valuable time, Ms. Shilpa. You've provided invaluable information.Shilpa: It was a pleasure helping you with your queries, Ms. Aarti. I truly appreciate your concern for people with Diabetes. Have a wonderful day.Pooja Kamthe is a Diabetes educator.
It was around 4:00 p.m. when Shilpa, a dedicated Diabetes educator, received a call from the helpdesk. She was informed about a visitor and kindly asked them to send the guest to her office. A few moments later, a poised and smart-looking young woman, about 30 years old, entered the room.Aarti: Good evening, Ms. Shilpa. My name is Aarti.Shilpa: Good evening, Ms. Aarti! Please have a seat. How can I assist you today?Aarti: I work as a counselor and coordinator at an old age home. Our residents come from diverse cultural and religious backgrounds, and many of them have Diabetes. Recently, I've noticed that some residents experience health complications when they fast for religious or social reasons. I would like to learn more about how fasting affects individuals with Diabetes and whether it can be done safely. Could you guide me?Shilpa: That's an excellent and thoughtful question, Ms. Aarti. Fasting can indeed pose challenges for individuals with Diabetes, but it's possible to approach it safely with proper planning and care.From a medical perspective, fasting is generally not recommended because of the potential risks, especially for those with fluctuating blood glucose levels. However, for individuals with well-controlled Diabetes (managed through diet and exercise alone) fasting can be considered safe if done cautiously.For others, especially those on medication or insulin, fasting requires extra care. If someone with Diabetes is determined to fast, they should consult their healthcare provider to create a tailored plan. This includes monitoring blood glucose levels, adjusting medications if necessary, and staying hydrated. With the right guidance and precautions, fasting can sometimes be accommodated while minimizing risks.Aarti: Precautions? Could you explain that further?Shilpa: Of course! Before fasting, it's crucial for anyone with Diabetesyoung, adult, or elderlyto consult their doctor. A complete Diabetes checkup is highly recommended to ensure there are no underlying complications. If any issues are identified, it's safer to avoid fasting to prevent health risks.Aarti: Could you help me understand what happens to the body when someone fasts?Shilpa: Certainly. Insulin plays a vital role in the body. Its primary function is to regulate blood glucose levels. It helps transport excess glucose from the blood into muscles and the liver, where it is stored as glycogen to maintain stable blood glucose levels. Insulin also supports fat synthesis, reducing free fatty acids in the blood.During fasting, in healthy individuals, when meals are skipped, blood glucose levels naturally decrease, and insulin production adjusts accordingly. The body compensates by using stored glucose from the liver and muscles, in the form of glycogen, to maintain energy levels. Counter-regulatory hormones help in this process, ensuring the brain and red blood cells (both of which rely on glucose) continue functioning properly.When glucose availability reduces further, the body switches to using stored fats as an energy source. This process produces ketones, which are used as fuel by skeletal muscles, the heart, and other tissues. Fasting triggers, a complex metabolic response, but in healthy individuals, the body adapts effectively to maintain balance.Aarti: What happens when a person with Diabetes fasts?Shilpa: When someone with Diabetes fasts, several challenges arise because their body doesn't produce enough insulin or, in some cases, any insulin at all.Insulin is essential for the body's normal functioning, and Diabetes is usually managed with medications or insulin therapy.Unfortunately, some people with Diabetes mistakenly believe they don't need insulin or their medications while fasting. However, the body continues to produce glucose from stored sources in the liver and muscles because the brain and red blood cells depend on glucose to function. Without insulin or medication, this glucose cannot be stored back in the liver or muscles, leading to a rapid increase in blood glucose levels due to the action of counter- regulatory hormones.Additionally, insulin helps in fat synthesis. When insulin is absent or insufficient, fat synthesis halts, and the level of free fatty acids in the blood increases. The body then begins breaking down stored fats for energy, producing ketones as a byproduct. In people with Diabetes, this process can go unchecked, leading to an excessive buildup of ketones in the blood, causing a condition called ketosis.As ketone levels rise, the blood becomes more acidica condition known as diabetic ketoacidosis (DKA). This is extremely dangerous and often requires immediate medical attention, including admission to an ICU. While DKA is more common in people with Type 1 Diabetes, in rare cases, individuals with Type 2 Diabetes can also develop it. That's why it's crucial for anyone with Diabetes to consult their healthcare provider before fasting to ensure they stay safe.Aarti: So it's very important for persons to discuss their condition with their doctor before fasting!Shilpa: Absolutely! Consulting a doctor is essential because they can adjust the medications and their timing based on the type of fasting. For instance, somepeoplefastfor24hourswithonlywater,while others fast from dawn to dusk, abstaining from both food and water. Each type of fasting requires a tailored approach. If the person is on insulin, the doctor may need to modify the doses to match the changed meal pattern. In some cases, the type of insulin may also need to be switched, as different insulins work in different ways.Additionally, it's crucial to reduce physical activity during fasting to prevent hypoglycaemia, which is a drop in blood glucose levels. Prolonged fasting, such as going without food for 24 hours or more, is strongly discouraged for individuals with Diabetes due to the significant risks involved.Aarti: Why should the medications be changed or modified? Sugars are produced from the liver and muscles during fasting, right?Shilpa: That's correct, but certain medications, like sulphonylureas and insulin, can cause hypoglycemia if meals are skipped or reduced. Hypoglycemia occurs when blood glucose levels drop too low, leading to symptoms such as sweating, trembling, palpitations, headaches, and intense hunger. If these symptoms appear, it's crucial for the person to break their fast immediately to avoid severe complications.To prevent such situations, it's important to consult a doctor before fasting. They can adjust your medications, switching to those that are less likely to cause hypoglycemia. Similarly, insulin doses need to be carefully modified to align with the fasting schedule. This ensures a safer fasting experience while minimising risks.Aarti: Are there any other risks besides low blood glucose?Shilpa: Yes, there are. If someone skips their medications or insulin, their blood glucose levels can get very high, which can lead to a serious condition called diabetic ketoacidosis (DKA). This is more common in people with Type 1 Diabetes and can be life-threatening.If the fasting also includes not drinking water, it can cause dehydration. When the body loses too much water, it affects how everything works. The blood can become thicker, which makes it easier for clots to form. These clots can block blood flow and increase the risk of serious problems like heart attacks or strokes. That's why it's so important to talk to a doctor before fasting to avoid these risks.Aarti: Oh! I had the misconception that a person could completely stop taking insulin or other medications while fasting since they're skipping meals.Shilpa: That's a common myth, Ms. Aarti. Many persons believe the same, and it often leads to complications. The truth is, skipping insulin or medication under the assumption that they aren't needed can cause blood glucose levels to rise significantly, resulting in severe hyperglycemia that may require hospitalisation. On the other hand, some persons overeat or consume high-sugar foods after fasting all day, thinking it will make up for the missed meals. This too can cause a dangerous spike in blood glucose levels.The risks of complications from fasting vary from person to person. Those who manage their Diabetes with diet and exercise alone, or use medications like metformin, acarbose, or incretin-based therapies, are generally at a lower risk of complications provided the dosage and timings of their medications are adjusted appropriately.Aarti: Who are considered high-risk persons?Shilpa: High-risk persons include:• Those with an HbA1c level (three-month average blood glucose) greater than 7.5 per cent.• People with kidney disease, heart problems, or a history of stroke.• Individuals living alone and taking medications like sulphonylureas or insulin.• Elderly adults in poor health.• Persons on psychiatric medications.• Anyone who has had severe or repeated low blood glucose (hypoglycemia) or diabetic ketoacidosis in the three months before fasting.• Those with hypoglycemia unawareness, meaning they don't feel the usual symptoms of low blood glucose.• Pregnant women with Diabetes.These individuals face a higher risk of complications while fasting and should always consult their doctor before attempting it.Aarti: So, it's always advisable for people with Diabetes who are at a higher risk to avoid fasting, right?Shilpa: That's correct. For high-risk individuals, fasting is generally not recommended due to the serious health complications it can cause. However, if a person still wishes to fast, it requires careful planning and close monitoring.First and foremost, they should consult their doctor to determine if they are fit to fast. Regular monitoring of blood glucose is essential. Using a continuous glucose monitoring (CGM) system is ideal as it provides real-time data and helps identify trends in blood glucose levels..If hypoglycemia occurs during fasting, they should break the fast immediately by consuming 15 grams of glucose or sugar (about 3 teaspoons) and recheck their sugar levels after 15 minutes. If symptoms persist, they should seek medical care without delay. Similarly, fasting must be stopped if blood glucose levels exceed 300 mg/dL or if symptoms of hyperglycemia arise.It's also essential to reduce strenuous physical activity during fasting hours to prevent low blood glucose. Light activity or exercise can be done after breaking the fast. Working with a dietician to create a tailored meal plan is critical, as calorie and nutrient needs vary for each individual.Under the updated guidelines, it's also advised to prepare for fasting by monitoring blood glucose trends for at least two weeks beforehand.Adjustments to medication and insulin doses must be made by the healthcare team based on the fasting schedule, whether it involves complete abstinence from food and water or only food restrictions. Following these steps can help reduce risks, but fasting should always be approached cautiously and under medical supervision for individuals with Diabetes.Aarti: What is continuous glucose monitoring?Shilpa: Continuous glucose monitoring, or CGM, is a technology that uses a small sensor placed under the skin to measure glucose levels in real-time. The sensor checks glucose levels every few minutes and sends the data wirelessly to a receiver, smartphone.Modern CGM devices provide detailed insights by tracking glucose trends throughout the day and night. They not only show current glucose levels but also provide arrows to indicate whether glucose is rising, falling, or stable. This allows persons and doctors to spot patterns, such as sudden spikes or drops, and make informed decisions about treatment, diet, and activity.Some CGM systems also send alerts when glucose levels go too high or too low, even while the person is sleeping. The data can be shared remotely with healthcare providers or family members, making it easier to manage Diabetes more proactively.The information from CGMs helps doctors make precise adjustments to medications or insulin doses and tailor the treatment plan to the individual's needs. It's a game-changer in Diabetes management, providing both convenience and better control over blood glucose levels.Aarti: That's really great. This can help prevent complications to some extent.Shilpa: Yes, continuous glucose monitoring provides a clear picture of how blood glucose levels fluctuate throughout the day, which helps individuals with Diabetes better manage their blood glucose. It's also important for caregivers, family members, and friends to be aware of the symptoms of hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), so they can recognize them early and assist the person if needed.This is particularly crucial for preventing situations like hypoglycemia unawareness, where the person with Diabetes may not feel the symptoms themselves. Caregivers should know how to check blood glucose levels, what to do in case of hypoglycemia, and how to handle any emergencies that may arise.It's also vital that persons and their caregivers are counseled on when to break the fast. If someone with Diabetes fasting feels unwell or experiences any unusual symptoms, they should stop fasting immediately. I hope I've been able to address your questions, Ms. Aarti.Aarti: Thank you so much for your valuable time, Ms. Shilpa. You've provided invaluable information.Shilpa: It was a pleasure helping you with your queries, Ms. Aarti. I truly appreciate your concern for people with Diabetes. Have a wonderful day.Pooja Kamthe is a Diabetes educator.
