Verily all praises belong to Allah, we praise Him, we seek his help and forgiveness. We repent to him. We seek refuge in him from our evil souls and the wicked consequences of our deeds. Whomsoever Allah guides, no one can misguide him, and whosoever he leads astray, no one can guide. I testify, there is no deity worthy of worship except Allah, and Muhammad (saw) is his final and last messenger.
I am writing this guide for the sake of Muslims who are diabetic and wish to fast. Fasting in the month of Ramadan is compulsory for all mature healthy Muslims. As such, it is very important as it is one of the pillars of Islam. There are lots of spiritual and healthy benefits associated with fasting; it is a month of revelation, as Allah revealed the glorious Qur’an, it is a month of forgiveness, it is a month of multiplication i.e., the reward for good deeds are multiplied. The virtues of Ramadan are too numerous to mention.
However, this write-up centers mainly on the health benefits of Ramadan relating it to other medical diseases and how to prevent complications arising from these diseases.
DIABETES AND RAMADAN PREPARATION.
In 2019, the number of people living with diabetes worldwide was estimated to be 463million and is estimated to be 700million by 2045. Islam being a fast-growing and the second-largest religion in the world, there are lots of Muslims who are diabetic and are willing to fast in the month of Ramadan. People living with diabetes are many in countries like Nigeria, the Middle East, and other countries with a majority of Muslim population.
A recent survey in 39 countries involving a sample size of 38000 Muslims reported that 93% fasted during the month of Ramadan and about 42.8% of people with type 1 diabetes fasted while 78.7% of those with diabetes type 2 fasted.
Because of the metabolism nature of this disease, there are potential health hazards that could be worsened during fasting as there are changes in food and fluid intake, potential hazard includes hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydrated.
Although Ramadan fasting can also provide health benefits and glucose control, it is important we strike a balance so the diabetic patient can utilize the health benefits of fasting as against the potential complications. Hence before the commencement of Ramadan, it is important that one knows how much blood sugar has been controlled in the past 3 months.
If an adequate record has not been kept as there has not been a personal glucometer machine, then, HBA1c is recommended prior to fasting. Those who have had episodes of DKA prior to Ramadan shouldn’t fast, for those with diabetes type 1 or those on insulin, it is also recommended to do a renal function test. Those who have distorted electrolytes should be corrected before the commencement of Ramadan fasting.
The table above shows the risk involved those above score 7 shouldn’t fast those who are low risk should fast and those who are moderate risk should fast with care, better still advice’s not to fast.
Hence, it is important to stratify and score you to be sure you are not at risk of developing debilitating complications prior to the commencement of Ramadan.
Self-monitoring glucose should be done at home if blood sugar is not controlled before sahur, morning, midday, midafternoon, presunset, 2 hours after iftar, and anytime symptoms of hypoglycemia is suspected
SIMPLE NUTRITIONAL NEEDS OF A DIABETIC DURING RAMADAN
Despite their medical condition, many Muslims still force themselves and fast. Therefore, complex carbohydrates are recommended for sahur, such as barley, wheat, oats, millet, semolina, beans, etc. Simple carbohydrates should be consumed during iftar such as rice, pounded yam, Eba, these should be taken with discretion.
Soda drinks, high sugary drinks should be avoided, fatty fried food like baked cakes, samosa, meat-pie should be avoided.
The male diabetic patients needs about 1500kcal/day of nutrition while, the female needs 1200kcal/day and this must be maintained during ramadan, hence your sahur and iftar is of importance
Food should have about 45-55 percent complex carbohydrates, fruits, and salad, use a small amount of oil during cooking, ensure you drink enough water during sahur and after iftar, run away from sweetened drinks and caffeine. Refined carbohydrates, white bread, cakes, sweetened zobo, and sweetened Kunu should be avoided after iftar. It predisposes one to develop hyperglycemia over the night.
Milk, skinless chicken, cashew, groundnuts and yoghurt, walnuts, beans are highly recommended. Incorporate olive oils, palm oil( do not bleach or roast) fish oil, vegetable oils in your cooking. Also, ensure that your intake of cholesterol is less than 300mg/day.
Red meat; fried or boiled should be minimized as it increases the risk of stroke in diabetics patients.
Rigorous physical activities should be avoided at all costs, Taraweeh is already enough physical activities during Ramadan. Make sure you begin iftar with plenty of water to overcome dehydration from fasting, keep physically active, do not sleep longer than usual, and ensure your glucometer is handy
Fever with diabetes during Ramadan is a deadly combination as this can tilt you into diabetic ketoacidosis, infections complicate diabetes mellitus, and worsen it during fasting.
USING YOUR MEDICATIONS.
If your blood glucose is persistent high before Ramadan and you are placed on metformin, your doctor will tailor it according to your sugar level.
Take your metformin slow release after sahur, if once daily, there is no need for dose adjustment. If twice daily, there is no need for adjustments, take at sahur and iftar, if 3 times daily, combine afternoon with the one you are taking during iftar, same with those taking sulfonylureas, but those with well-controlled sugar, sahur dose should be reduced.
If you are taking thiazolidine, no need to adjust dose, take it during iftar, because of the risk for hypoglycemia.
Those on insulin are not advised to fast because of the significant risk of hypoglycemia, although those using insulin glargine basal insulin have been seen to be safer during Ramadan even in combination with oral antidiabetic.
Those taking basal insulin, if once daily, should only take insulin at iftar and dosage should be reduced by 15- 30 percent.
If twice daily, take the usual morning dosage at iftar and reduce dosage by 50 % and take at sahur. However if blood glucose is less than 70mg/dl during iftar reduce insulin by 4units, if between 90- 126mgdl, no need to change if less than 90mg/dl reduce by 2units, if greater than 126mg/dl increase by 2unit, and if greater than 200mg/dl increase by 4units, same should be applied with short-acting insulin.
After EId fitr, it is very important for follow-up with your doctor as majority overindulge in feasting, which tilts them into hyperglycemia or diabetic ketoacidosis, a life-threatening medical emergency.
Cc.
Omokhefe Biem
Reference: Diabetes and Ramadan 2021 guidelines.
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