JEDDAH: Fasting during Ramadan can be a challenge for diabetic patients as their blood sugar levels can drop. It can be dangerous as some people are at high or moderate risk of developing health problems due to fasting, a consultant endocrinologist told Arab News.
An assessment is vital for diabetic patients who intend to fast as they need to evaluate the risks and educate themselves on medication and diet adjustments, according to Dr. Muneera Al-Shareef, who works at a hospital in Jeddah.
“All patients with diabetes wishing to fast should have a pre-Ramadan assessment with a health care professional (HCP), ideally six to eight weeks before the start of Ramadan,” Al-Shareef said.
She added that the assessment would include taking a detailed medical history and reviewing the patient’s glycemic control, risk of hypoglycemia (glucose deficiency in the blood steam) and self-management capabilities, as well as recommendations regarding treatment and any dose adjustments that may be required.
“Patients taking metformin, short-acting insulin secretagogues, sulphonylureas drugs or insulin will need to make adjustments to dose and or timings to reduce the risk of hypoglycemia while maintaining good glycemic control,” the endocrinologist said.
Patients may be advised not to fast if it is not safe for them or to change their medication. If fasting, patients must be aware of low blood pressure symptoms that include, feeling sweaty, dizzy and anxious as well as going pale and having palpitations, the physician said. Symptoms of high blood pressure will include feeling thirsty, passing urine frequently and fatigue.
In some cases, risks associated with fasting include hypoglycemia, hyperglycemia (high blood sugar), diabetic ketoacidosis, which occurs when the body cannot produce enough insulin. “All diabetic patients should break their fast if their blood glucose is 300 mg/dL or suffer from symptoms of hypoglycemia, hyperglycemia, dehydration or if an acute illness occurs,” Al-Shareef said.
Diabetic pregnant women are among those who are prone to develop health risks due to fasting. Three quarters of Muslim pregnancies overlap with Ramadan and “the risking (of the health) of both the mother and fetus means that pregnant women are exempt from fasting,” Al-Shareef said.
She added: “Patients who fast against the advice provided by their HCPs should follow experts’ detailed guidance to avoid the development of serious complications.”
If diabetic patients choose to fast, they need to avoid sweet beverages, which are common on Ramadan’s iftar table and drink water instead to maintain adequate hydration. Al-Shareef said sweets and desserts that are high in sugar should be avoided and replaced with a “moderate amount of healthy dessert” such as a piece of fruit.
A healthy iftar meal for a diabetic patient would include carbohydrates that are high in fibers, cooked or raw vegetables, whole fruit, yogurt and dairy products. The doctor added that the “consumption of carbohydrates from sugary and highly refined grains, such as wheat flour, cornstarch, white rice and potatoes, should be avoided or significantly minimized.”
As for suhoor, the pre-fasting late meal, Al-Shareef said it should be taken as late as possible especially before a 10-plus-hour fast. “Eating large meals at iftar may result in postprandial (after meal) hyperglycemia and weight gain, while having large and frequent snacks between the two main meals can contribute to longer periods of hyperglycemia.”
Saudi Arabia is among the countries with the highest prevalence of diabetes. According to the World Health Organization (WHO), over 2.5 million people will have diabetes by 2030.