With Ramadan approaching (26 May- 24 June), Diabetes Nurse Educator Razana Allie explains how having diabetes and fasting during Ramadan can be manageable.
The 26th of May is the start of most important month of the 2017 Muslim calendar. This month signifies and reaffirms our commitment to Islam and the five pillars which we conform to as Muslims. Islam is a way of life, and fasting is bestowed upon us as soon as we enter puberty until the time of death. As a Muslim, not fasting is a violation of who we are.
Sin, guilt, dishonesty and embarrassment are but a few words to describe what most feel when not fasting. The threat of developing complications or even death when fasting with an acute/chronic condition is not sufficient to deter most from fasting. This may result in complications which may have been prevented.
Diabetes is a chronic condition which, with education and support, can be managed to prevent complications and obtain a good quality of health.
During Ramadan, many factors influence the quality of our fasting day. Maintaining normal blood glucose while fasting is quite a challenge even to the person without diabetes.
Late nights with Taraweeh (Ramadan prayers) and early mornings with Suhur (pre-dawn meal) means less sleep. Waking early for Suhur to keep you nourished and satisfied until Iftar (breaking the fast) is a challenge.
Mild hypoglycaemia, dehydration, lethargy is the order of the day, to continue for 29 to 30 days of the month.
In South Africa, it’s business as usual. Very few companies acknowledge fasting and how difficult it is. Work life is the same as the other 11 months of the year. Expectations to perform continue, which is added pressure while fasting.
Possible complications while fasting may be:
Hypoglycaemia – While fasting there is no opportunity to correct the hypoglycaemia, which may lead to symptoms including confusion, irritability, coma or hospitalisation if witnessed. The liver provides glucose throughout the day until it becomes depleted of its stores.
Dehydration – may occur as fluid intake is only allowed at night and not during the day.
Thrombosis – the formation of blood clots. More prevalent with uncontrolled diabetes, cardiovascular disease, hypertension as well as dehydration.
Hyperglycaemia – may occur when medication is not taken to prevent hypoglycaemia while fasting.
Those who should not fast:
- People with uncontrolled diabetes who use multiple doses of insulin, especially Type 1 diabetes.
- Patients with long-term diabetes complications, such as kidney failure or heart disease.
- Women with gestational diabetes.
- Patients with a tendency of high blood glucose levels and those with high ketone levels.
Can blood glucose levels be managed during Ramadan?
Diabetes can be manageable with education, guidance and support, provided you are low risk.
During pre-Ramadan, it is advisable to visit your doctor and diabetes educator to measure control and risk. This visit should also provide education on how to manage your blood glucose levels while fasting. Discussion on dosage reduction and target blood glucose for the month is important.
Management of hypoglycaemia as well as hyperglycaemia should be stressed and confirmed. Exercise is usually minimal during Ramadan, and most regard Salaah, during Taraweeh, as a form of exertion like exercise. However, parking far from the entrance at work or when shopping, and taking the stairs instead of the lift is manageable and acceptable forms of exertion.
Correct meal choices are important to get through the month of Ramadan. Minimal fats and carbohydrates, especially at Iftar, and additional proteins at Suhur is recommended. Faloodah with a sweetener instead of sugar; air fried or baked samosas instead of deep fried; two dates instead of six when breaking fast; baked curry balls instead of deep fried. Cake, biscuits, donuts and koeksisters may be taken in moderation at Iftar, provided you’re aware of the consequences of high blood glucose levels when consuming these foods.
In addition to the low GI carbohydrates, proteins are recommended at Suhur to provide and maintain energy levels throughout the day.
An increase in the intake of fluids at night is important; this will minimise dehydration throughout the day. Monitoring blood glucose is essential, with additional testing two hours after Suhur and Iftar, and before Asr Salaah for possible hyperglycaemia after meals and hypoglycaemia late afternoon. Changing injection times and adjusting insulin and oral dosages discussed with your doctor and diabetes educator before Ramadan prevents untoward abnormal blood glucose levels during the month.
Revisit your doctor and diabetes educator post Ramadan to readjust your medication and plan a way forward.