Diabetes and Fasting During Ramadan

If you are planning to fast and you have diabetes, it is important to speak to your diabetes healthcare team as early as possible before Ramadan begins. For some people with diabetes, fasting can be dangerous. Your diabetes team will be able to advise you on whether it is safe for you to fast. If you are able to fast, they will advise you on how to manage your condition throughout the fasting period.

Possible Complications of Fasting during Ramadan
Fasting among patients with type 1 diabetes, and among those with type 2 diabetes who have inadequately managed blood glucose levels, is associated with multiple risks. Some of the major potential diabetes-related complications of fasting include dangerously low blood glucose (hypoglycemia), excessively high blood glucose (hyperglycemia), diabetic ketoacidosis and thrombosis (blood clots).

Hypoglycemia and Hyperglycemia
Hypoglycemia is the fall of blood sugar under the normal levels (less than 70mg/dl – 3.9mmol/l). Hyperglycemia is the rise of blood sugar above normal levels (above 200 mg/dl – 11.1 mmol/l) which may lead to diabetic Ketoacidosis in type 1 diabetes patients.

Diabetic Ketoacidosis
When the body’s cells don’t get enough glucose, it starts to burn fat for energy. When the body burns fat instead of glucose it causes waste products called ketones. Ketones can make the blood acidic and this can be dangerous. The risk for diabetic ketoacidosis may be further increased due to excessive reduction of insulin – based on the assumption that food intake is reduced during the month.

Patients with type 1 diabetes who choose to fast during Ramadan are at a higher risk of developing ketoacidosis, especially if they have been experiencing hyperglycemia frequently before Ramadan.

Dehydration and Thrombosis
Fasting during Ramadan can cause dehydration due to the lack of fluid intake as well as the hot and humid weather in the country. Dehydration can then result in a higher blood viscosity (stickiness), which increases the chances of thrombosis (blood clots). For diabetics who choose to fast during Ramadan, it is important to drink plenty of water during non-fasting hours. Staying hydrated can help prevent dehydration and associated complications.

Management
For individuals with diabetes who choose to fast during Ramadan, several topics require specific consideration, including monitoring of blood sugar, nutrition, exercise, pregnancy and fasting. It is also important to recognize that fasting is not recommended for all people with diabetes

Frequent Monitoring of Blood Sugar
If you are diabetic and you choose to fast during Ramadan, it is recommended you check your blood sugar levels frequently throughout the day; this is especially critical for patients who require insulin. It is recommended to check blood sugar levels at least four times a day:
  • Between 10:00 am and 11:00 am
  • Between 3:00 pm and 4:00 pm
  • 3 hours after Iftar
  • Directly before Sahoor
If signs of hypoglycemia or hyperglycemia (low or high blood sugar) occur, breaking ones fast is recommended in order to normalize blood sugar levels and to prevent more dangerous complications.

A physician or diabetes educator can provide more details about controlling blood sugar during Ramadan and helping patients understand when it would be necessary to break their fast.

Nutrition
A healthy and balanced diet during Ramadan is recommended for everyone, but especially for those who have diabetes or are pre-diabetic. Following the below tips is recommended:
  • Consuming large meals at Iftar and/or foods that are high in fat and carbohydrates should be avoided. Starting meals with a small amount of food that is rich in simple carbohydrates and can be absorbed quickly by the body, such dates or milk, is recommended.
  • Taking the Sahoor meal as late as possible before the fasting time starts, and including foods that are rich in complex carbohydrates, such as whole grain bread or vegetables, is also recommended. Complex carbohydrates take more time to digest, absorb and ingest, keeping the body fueled for more hours throughout the fasting day.
Check out our Diabetes Cookbook for healthy recipes, such as Biryani and Thereed, that have been adapted to be more diabetic friendly.
 

       
Exercise
Normal levels of physical activity can be maintained for most diabetics who choose to fast. Although, exercise during fasting hours, especially before Iftar, is generally discouraged as it may lead to hypoglycemia. It is advisable to rest before Iftar; however, people with diabetes are advised to avoid sleeping during this period in order to remain alert to signs of hypoglycemia (which is more likely to occur during the later hours of the fasting day).

Pregnancy and Fasting
While there is some controversy surrounding this subject, fasting during pregnancy is believed to carry a high risk for both the mother and her unborn baby. Pregnant Muslim women are exempt from fasting during Ramadan.

When you Should Not Fast
It is advised that you do not fast if you are/have any of the following:
  • Fragile or unstable diabetes
  • Type 1 diabetes
  • Chronic complication such as kidney failure and macrovascular complications
  • Pregnant
  • Undergoing dialysis
  • Poor glycemic control
  • Unaware of hypoglycemia or have recurrent hypoglycemia
  • Ketoacidosis or hyperosmolar hyperglycemia coma within the three months before Ramadan
Ramadan Nutritional Facts and Tips
Managing diabetes during Ramadan is all about smart management and making healthy choices. Some interesting information to note:
  • There are 250 calories in one piece of fried samboosa and 125 calories in a baked samboosa. Try baking samboosa instead of frying and consume one to two pieces maximum. Also, try to use light fillings, like low fat cheese.
  • Avoid adding butter or ghee to Harees, Jareesh or other foods.
  • Drink 8-10 cups of water between Iftar and Sahour meals.
  • Avoid eating more than three dates per day. Each date provides 20 calories and contains one teaspoon of sugar. It is best to start your Iftar meal with dates to get your blood sugar back to normal levels.
  • Try to eat/drink low fat soup options, like vegetable and lentil soups. If you plan to have a cream soup, replace the cream with skimmed milk.
  • Cheese or walnut katayef can range from 200 to 400 calories a piece. Avoiding these foods is recommended; however, if you choose to eat them once in a while, bake them instead of frying and choose low fat fillings and reduce the density of the sugar syrup.
  • The best time for exercise is during the evening (two hours after the Iftar meal). Going to Taraweeh Prayers can also be considered as part of your daily exercise regime during Ramadan.