Ms. Manal Musallam, Director of Diabetes Education at Hamad Medical Corporation’s (HMC) National Diabetes Center says Ramadan can be one of the most critical times of year for diabetics.
“Diabetes, both Type 1 and Type 2, is a condition that requires careful management, blood sugar control, appropriate diet, and for many patients strict adherence to medication regimes. Ramadan can be a very challenging time of year for diabetics who choose to fast because fasting alters the timings of meals and disturbs sleeping patterns, both of which can affect a person’s metabolic state,” says Ms. Musallam.
Patients with diabetes who are able to safely fast are advised to avoid making major changes to their diet during Ramadan. Ms. Musallam says it is important that diabetics do not break their fast with a large, excessive meal as there is the risk of post-meal hyperglycemia (high blood sugar).
“Meals eaten during Ramadan are often large and contain fried and sugary foods which can have an impact on blood glucose control. Iftar often turns into a celebration for many families. For diabetics, it is important to ensure that Iftar remains a meal and does not become a feast,” said Ms. Musallam.
Hyperglycemia, or high blood sugar, can be caused by an increase in food or sugar intake or by an excessive reduction in dosages of diabetes medications. Symptoms of hyperglycemia include a dry mouth, blurred vision, increased thirst, and frequent urination. Ms. Musallam says during Ramadan diabetics should follow Prophet Muhammad Sunnah’s instruction and break their fast with one date and a sip of water, followed by prayer. She says this will help encourage the digestion process and will also help prevent a sudden rise in blood sugar. During Ramadan patients with diabetes are advised to eat as they normally do, with the only difference being the timing of meals rather than the quantity or type of food consumed.
Each year, HMC in collaboration with the Qatar Diabetes Association, operates a diabetes hotline. The phone-based emergency service provides individuals with diabetes, as well as their relatives or caregivers, with medical advice related to diabetes and fasting. Ms. Musallam says many of the calls received are questions about medication adjustments and people trying to find out if it is medically necessary to break their fast. She says that many of the complications diabetics encounter during Ramadan are preventable, underscoring the importance of consulting a doctor before fasting.
“Having diabetes may place an individual at risk of a number of health complications. We know that pre-Ramadan counseling reduces the incidence of hypoglycemia (low blood sugar), hyperglycemia, dehydration, ketoacidosis, and other diabetes complications. In the weeks and months leading up to Ramadan we devote a lot of resources to talking to patients about the risks associated with fasting with diabetes as well as providing advice on how to fast safely,” noted Ms. Musallam.
Pre-Ramadan assessments normally include a physical evaluation, counseling on recommended physical activity, meal planning, glucose monitoring and guidance on required dosage and timing medication changes. Ms. Musallam says that while individuals with Type 1 diabetes are generally advised not to fast, most Type 2 diabetics are able to fast without complications, provided they have received approval from their healthcare team.
“A pre-Ramadan assessment is important for both patients and their caregivers as we review a lot of the common conditions or emergencies that diabetics may encounter during fasting. We also remind patients about the importance of listening to their own body. This is extremely important as each person's reaction to hypoglycemia, for example, is different. Signs and symptoms of hypoglycemia can include sleepiness, sweating, shakiness, confusion, irritability, and hunger, but some patients will have no symptoms at all,” says Ms. Musallam.
Diabetics who are fasting are reminded of the importance of monitoring their blood glucose regularly. Ms. Musallam also cautions against rigorous exercise during fasting, noting that it increases the risk of hypoglycemia, dehydration, and thrombosis.
The HMC and Qatar Diabetes Association Ramadan phone-based emergency service is available seven days a week from 8pm to 11pm on 5598 1331.
The Ministry of Public Health, HMC, and Primary Health Care Corporation (PHCC) have partnered again this year to re-launch the Ramadan Health website and have expanded the initiative by introducing a companion smartphone and tablet app. Introduced two years ago, the Ramadan Health website is Qatar's first online resource devoted to health and wellness during the Holy Month. Visit the Ramadan Health website at www.hamad.qa/ramadanhealth, or download the app to your phone or tablet by searching for ‘Qatar Health’ (available for iOS and Android operating systems).