It is worth reemphasizing that fasting for patients with diabetes represents an important personal decision that should be made in light of guidelines for religious exemptions and after careful consideration of the associated risks following ample discussion with the treating physician. Most often, the recommendation will be to not undertake fasting. However, patients who insist on fasting need to be aware of the associated risks and be ready to adhere to the recommendations of their health care providers to achieve a safer fasting experience. Patients may be at higher or lower risk for fasting-related complications depending on the number and extent of their risk factors.
Several important issues deserve special attention.
Perhaps the most crucial issue is the realization that care must be highly individualized and that the management plan will differ for each specific patient.
Frequent monitoring of glycemia.
It is essential that patients have the means to monitor their blood glucose levels multiple times daily. This is especially critical in patients with type 1 diabetes and in patients with type 2 diabetes who require insulin.
The diet during Ramadan should not differ significantly from a healthy and balanced diet. It should aim at maintaining a constant body mass. The common practice of ingesting large amounts of foods rich in carbohydrate and fat, especially at the sunset meal, should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing “complex” carbohydrates may be advisable at the predawn meal, while foods with more simple carbohydrates may be more appropriate at the sunset meal. It is also recommended that fluid intake be increased during nonfasting hours and that the predawn meal is taken as late as possible before the start of the daily fast.
Normal levels of physical activity may be maintained. However, excessive physical activity may lead to higher risk of hypoglycaemia and should be avoided, particularly during the few hours before the sunset meal. If Tarawaih prayer (multiple prayers after the sunset meal) is performed, then it should be considered a part of the daily exercise program.
Management of patients with type 2 diabetes
In patients with type 2 diabetes who are well controlled with diet alone, the risk associated with fasting is quite low. However, there is still a potential risk for occurrence of postprandial hyperglycemia after the predawn and sunset meals if patients overindulge in eating. Distributing calories over two to three smaller meals during the nonfasting interval may help prevent excessive postprandial hyperglycemia. Patients controlled with diet alone usually combine this with a regular daily exercise program. The exercise program should be modified in its intensity and timing to avoid hypoglycemic episodes; the timing of the exercise could be changed to ∼2 h after the sunset meal.
At Lina’s & Dina’s Diet Center, we provide programs and meals for diabetic patients. Visit our different branches of Lina’s & Dina’s in order to control your blood glucose levels and the risk that may result from incorrect eating pattern. With our guidance you will prevent any health complications that may result from fasting during Ramadan.