How Does a Diabetes Patient Fast During Ramzan?

The month of Ramzan has started as have preparations for Sehri and Iftar. But how healthy is fasting for a diabetic?

Fasting during the month of Ramzan or observing Roza is connected to the religious beliefs of people. 

(Photo: iStockphoto)

Ramzan has already started and you probably are already preparing for Sehri and Iftar. But how prepared are you from the point of view of health?

Fasting during the month of Ramzan or observing Roza is connected to the religious beliefs of people. Despite various health instructions, some people with serious health conditions continue to observe Roza.

Matters become serious when you have diabetes and you have to fast for over 15 hours in the scorching heat, even though strict instructions are given to diabetics to not remain empty stomach for extended periods of time.

My mother-in-law who is extremely religious has been suffering from diabetes for the past 30 years, but she observes the Roza every time.

Is this possible for every diabetic? What happens when someone with diabetes doesn’t eat or drink for over 15 hours?

What Goes on in Your Body When You’re Fasting?

Changes in the body during fasting depend largely on time period of the fast. (Photo: iStockphoto)

Changes in the body during fasting depend largely on time period of the fast. Usually your body is in a state of fasting 8 hours after your last meal. Initially the body uses up the sources where glucose is deposited. During the fast the body breaks down deposited fat for energy. However, use of body fat for energy for extended periods of time can become a reason for weight loss, especially when you are overweight. This leads to better control over blood sugar, blood pressure and cholesterol levels.

But how does your body react to a fast if you’re diabetic?

According to Diabetes UK, glucose levels can increase drastically when you’re fasting. This can lead to a condition known as diabetic ketoacidosis (DKA), where there is extra production of blood acids (Ketones). This can lead to vomiting, nausea, dehydration, panting, confusion and in extreme cases coma. It may also lead to development of Thrombosis in the body, resulting in formation of blood clots.

Speaking to FIT, Dr S K Wangnoo, Senior Consultant, Diabetes Specialist, Apollo Hospital, said:

Medicines while fasting can also lead to low sugar levels, which is extremely dangerous. 

Dr S K Wangnoo

What Do the Experts Say?

Dr Vikas Ahluwalia from Max Super Speciality Hospital advises,

If you are a diabetes patient but want to fast during Ramzan, it is always better to consult a doctor for any precautionary measures that you might need to take. 

Dr S K Wangnoo adds, “We usually advise against fasting if you are a diabetic. But if the patient has to keep a fast then it is advised to have a short acting insulin at hand which the patient needs to take in the morning before Sehri and in the evening after breaking their fast.”

Doctors usually give long-acting medicines, which reduces the patient's sugar level. But while keeping Roza, sugar levels become very low. It is therefore important that you meet the doctor beforehand. After the end of Ramzan, you can come back to your regular medicines.

We usually advise short acting medicines for people who take tablets. This is so that, long acting medicines do not lead to low blood sugar during the fast. 

Dr S K Wangnoo, Senior Consultant, Diabetes Specialist, Apollo Hospital

According to Dr. Wangnoo, if you are sweating too much or feeling fatigued and weak then one should break the fast immediately and consume some food.

He also adds that including fibre, salad and fruit in your diet is extremely important. Red meat should be avoided. Consumption of fish and chicken is advised.

Glycemic Index and Diabetes

Fasting diabetics should include lower glycemic index food items in their diet.(Photo: iStockphoto)

According to Diabetes UK, fasting diabetics should include lower glycemic index food items in their diet. So what is the lower glycemic index?

Carbohydrates are an important part of our diet, but not all carbohydrates in food are alike.

Given the effect of carbohydrates on blood glucose levels, glycemic index is the method of ranking of carbohydrates in foods. Carbohydrates with low glycemic index are the ones which are absorbed slowly and are ranked at 55 or below. They dissolve, metabolize and digest in the body at a slow pace, which increases blood glucose on a low speed, thereby reducing insulin resistance.

According to American Diabetes Association, the following are lower glycemic food items:

• Rye bread
• Pure wheat flour bread
• Oatmeal
• Oats
• Barley
• Muesli
• Pasta
• Changed rice (changed from brown rice to white rice)
• Fruits, Non - starchy vegetables and carrots
• Sweet potato, corn, arbi, lima beans, peas, flax, lentil pulses

Dr Wangnoo says that it is necessary to include high fibre in your diet during Sehri so that you sugar remains in control till you break the fast.

Fasting diabetics should break their fast with almonds, walnuts and dates. Consume coconut water or unsweetened shikanji. They are also advised to consume complex carbohydrates so that they take time to dissolve, and consume simple carbohydrates while breaking the fast so that you can get energy quickly. 

Dr Vivek Kaul, Diabetes Dietitian, Apollo Hospital