Ramzan, the annual fasting month for Muslims, is here. In a country with a large population of Muslims, the number of people doing this holy fast this August-September is huge. However, not all of them are healthy enough to do this month-long fast. Many suffer from illnesses because of which prolonged fasting can lead to trouble. Take diabetics for instance. We know that the timing of meals and regular medication remains the mainstay of most diabetes treatment. During Ramzan, people abstain from eating, drinking (even oral medications), from predawn to sunset.
“However, this can be harmful to diabetics particularly those who are at the risk of hypoglycaemia (blood glucose levels less than 70 mg/dl),” says Dr. Sujeet Jha, Head of Endocrinology, Diabetes and Obesity, Max Health Care, New Delhi. High blood glucose levels can occur due to diet modification and change in meal timing. “Praying five times a day along with night time prayer (tarawih) involves exercise which may also lead to dehydration and hypoglycaemia,” he adds.
So, the important thing to do is to change of medicines before fasting. “All patients with diabetes, who intend to fast during Ramzan, should consult their physician and undergo a counselling session as to how to monitor their bodies during the fast,” he suggests. It is important for patients, their family and friends to understand about the patients' care, including signs and symptoms of hyper-and hypoglycaemia, blood glucose monitoring and other acute complications. Importance of good nutrition and hydration should be emphasised, family should know how to treat a hypoglycaemic. Frequent glucose monitoring should be done, particularly in patients on insulin. To spread awareness, Max Health Care recently organised a session on diabetes management during Ramzan at Max Super specialty Hospital, Saket.
Points out Dr. Jha, “In large scientific studies (for instance, research by EPIDIAR Study Group) conducted in 13 Islamic countries involving 12,243 individuals with diabetes who fasted during Ramzan, showed a high rate of acute complications.” To avoid complications, he suggests the follow general rules.
Diabetics should try to maintain their body mass. A reasonable meal size, based on moderate quantities of starchy carbohydrates e.g. rice, chapattis, wholegrain bread, lentils and dalia (oats), should be taken during Sehri. Some of these foods release sugar (glucose) slowly which would maintain their sugar levels for a longer duration and would make them feel less hungry.
Traditionally, dates are taken during Iftari, diabetics can take a fewas a source of energy and fibre. The common practice of taking large amounts of food rich in carbohydrate and fat, such as burfi and jalebi, with Iftari should be avoided. Food rich in fibre, like fruits and vegetables with skins, should be taken to avoid constipation.
There should be water or fluid intake before the end of Sehri and it should be as late as possible. However, sweet or salted lassi made from full cream milk, mango pulp, canned juices and fizzy drinks should be avoided. Tea or coffee at Sehri should be avoided too as caffeine can stimulate water loss and dehydration by excessive urination.
Oral medication and diabetes
In India, patients can take a combination of up to three drugs. Certain drugs (salts) are safer, for instance, the risk of hypoglycaemia is less with Metformin, Pioglitazone Acarbose Voglibose and Sitagliptins Vildalaglitin and Saxagliptin. One should look into the strips to know the exact composition (salt), for example, Amaryl M1 contains two salts, Glimpieride and Metformin.
Certain types of drugs contain sulfonylurea, which may be unsuitable for some patients on fast due to their inherent risk of hypoglycaemia. “Short acting Secretagogues like Repaglinide can be used during Ramzan after consulting a doctor,” says Dr.Jha.
He also suggests those on insulin to meet their physicians before starting to fast, it's more so for patients with Type 1 diabetes. “Several types of insulin are used and long acting ones like Lantus or Levemir should be used on lower dosages despite being safer to avoid hypoglycaemia.”
Racting Insulin (Humalog ,Novorapid or Apidra) or short acting insulin like (Hun insulin R, Actrapid) can be taken with Iftari but dose adjustments have to be made if they are taking more than once. “Those persons taking mixed insulin like Human Mixtard or Huminsulin 30/70 can shift their morning dose with Iftari and the evening dose with sehri but this may need adjustment.” However, Hypoglycaemia can occur in patients even after taking precautions. Some of the symptoms could be excessive sweating, dizziness, paleness, headache, blurred vision, hunger, irritability and short temper, difficulty in concentrating, mood swings, difficulty in waking up, trembling, palpitations/irregular heartbeat, needling sensation in the lips, tongues, finger tips, slurring of speech and double vision, but there could be more serious symptoms like drowsiness or fainting of the patient. Ideally, a diabetic should end his/her fast by taking 150- 200ml of orange juice or cola or three tablespoon of sugar or glucose with water. It should be followed with slow release carbohydrate, for example, one or two pieces of a fruit, two plain biscuits, a slice of bread, and one small chapatti. .