Fasting is often a religious ritual recommended by almost every major religion of the world.

Ramadan, the ninth month of Islamic lunar

Hijri calendar, is marked by the religious

ritual 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 fasting

Diabetes 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 fasting

After 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 with

Diabetes, especially if they are prescribed

medication 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, dry

mouth, lips and skin. Dehydration increases the risk of thrombosis or clotting of blood

in 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 their

Diabetes 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, breastfeeding

and 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 offering

charity or providing food to the poor. Speak to your local Imam for more information about this. 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 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 Suhoor

At Suhoor you can eat starchy carbohydrates and slowly absorbed foods which release energy slowly, such as multigrain bread, oat-based cereals,

ASK DIABETES HEALTH

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