During Ramadan, diabetic children who are fasting experience blood sugar highs and lows depending on the food they consume, the dose of insulin they take and the amount of physical activity they perform.
The most important causes of these sugar highs and lows are irregularity of food intake and failure to adhere to the set schedule of insulin injections.
“All diabetic children should be aware that there is no single path for all children to follow to maintain healthy blood sugar levels. Guidelines differ according to a patient's health and variations in the timing, quantity and quality of food consumed and activity performed,” explained Dr. Noor Hamed, Associate Consultant of Endocrinology at Department of Endocrinology and Diabetes at Hamad Medical Corporation.
Dr. Noor highlighted two key potential complications for fasting diabetic children during Ramadan:
- Blood sugar levels fall to less than the normal level i.e. less than 70 mg or 3.9mmol/liter
- Increase of blood sugar level to more than the normal level 250 mm or 13.8mmol/liter, which may lead to infection from the Ketone acidity.
Insulin dependent diabetic children may fast during Ramadan provided their health is stable before fasting, and they are able to control their blood sugar levels so they are close to normal levels. The following steps should be followed for healthy fasting:
- Diabetic children should not have repeated periods of low or high blood sugar when fasting.
- The physician should choose the type of the insulin used and required dosage based on the patient's health and the amount of food taken between breaking fast and Suhoor to maintain normal; blood sugar levels.
- There should be careful self-monitoring of blood glucose levels during Ramadan. The diabetic child should measure their blood glucose levels when waking up in the morning and at 12 noon, 4pm, before breaking the fast, at 10pm and before Suhoor, and when necessary or on feeling symptoms of low or high blood sugar.
- Delay the Suhour meal, which should be taken shortly before Imsak.
- Take sufficient quantities of water and fluids at Iftar and Suhoor.
- Children with diabetes who depend on insulin treatment should keep a piece of candy in their pocket to eat when feeling symptoms of low blood sugar, so they can break their fast immediately.
Dr. Noor stressed the need for diabetic children to always be ready with the glucagon or glucose injection to raise their blood sugar level in cases of very low blood sugar. “Children should stop fasting and break their fast immediately if they feel symptoms of low blood sugar at any time even if little time is left for 'Adhan' of the Maghrib prayer,” she explained.
“Avoid fried, fatty foods and sweets because they considerably raise the levels of blood sugar as they contain higher calories. If they must have some sweets, they need to increase the fast-acting insulin dose so the blood sugar level rises, and drink more water to prevent high acidity in the blood,” advised Dr. Noor.