The month-long Islamic religious festival, Ramadan, when observant Muslims fast during daylight hours, is about to begin around the world but fasting can be extremely dangerous for diabetics.
Despite the fact that diabetics are not required to fast during Ramadan and that there are serious health risks involved, many choose to do so anyway. A study published in Diabetes Care suggests that as many as 43% of Muslim type 1 diabetics and and 79% of Muslim type 2 diabetics participate in the fast each year.
When is it ok to fast?
Health24's resident diabetes expert, endocrinologist Dr. Wayne May suggests that type 1 diabetics should never fast."Generally we will advise against fasting for type 1’s but there are type 2’s who can fast, e.g. patients on oral tablets, or who are on basal insulins only. Those on basal bolus or mixed insulins twice a day will need to check with their doctors. Patients with end organ complications like kidney failure also shouldn’t fast, as they are at increased risk of hypoglycaemia."
Fasting can put diabetics, especially those with type 1 at risk of low blood sugar (hypoglycaemia), a serious medical emergency that can result in seizures, coma and even death if not treated urgently. Hypoglycaemia is particularly dangerous when a diabetic lacks "hypo" awareness. This means that they do not experience symptoms of low blood sugar such as dizziness, rapid heart rate, sweating and confusion. Without these important warning signs, a hypoglycaemic diabetic is at a far greater risk of complications associated with dangerously low blood glucose.
For those who battle with high blood sugar (hyperglycaemia), a lack of water can lead to dehydration and extended high blood sugar may result in diabetic ketoacidosis, a life-threatening condition where fat is broken down into ketones, causing the blood to become to acidic.
For those with diabetes who are not well-controlled or do not have good hypo awareness, fasting should never be considered. Diabetics who would like to fast should only do so under the guidance of a medical professional.
Fasting safely with diabetes
As mentioned above, any diabetic who would like to fast should first seek the approval of their doctor. Your doctor will be able to make adjustments to your medication doses and schedule to minimise the risk of both hypo- and hyperglycaemia. They may also give you a target blood glucose range to adhere to. Some may recommend a specially formulated meal plan to sustain your blood sugar levels throughout the day.
Here are some important guidelines to follow when fasting with diabetes:
- Check your blood glucose levels more often than usual. Testing every three to five hours should be adequate.
- Ensure that you have a well-balanced breakfast that includes a healthy low-GI carbohydrate, some protein and some healthy fat (eg: boiled eggs and avocado on low-GI toast). This will assist you in sustaining healthy blood glucose levels throughout the day.
- Drink lots of water with your breakfast. You may not feel like drinking water in the morning but this will assist you in keeping hydrated throughout the day.
- Avoid physical activity during the day. Exercising without eating is a big no-no for diabetics. If your job requires physical activity, ensure that you are checking your blood glucose often.
- Avoid caffeine as it is a diuretic and can contribute to dehydration.
- Wear your Medic-Alert bracelet or something similar that identifies you as diabetic.
- Keep some sugar nearby in case of a hypo. A good idea is to buy rolls of Super-C sweets and stash them in your pockets, handbag, the cubby hole of your car and your desk drawer at work.
- Avoid sugary or high-carbohydrate foods in the mornings or evenings as this will destabilise your blood glucose levels (this does not apply if you are treating a hypo
- If your blood glucose is below 4.0 mmol/l and you are going into hypoglycaemia, then you need to break your fast, even if you are not experiencing the symptoms. Be sure to eat something and test your blood glucose again 20 minutes later.
- If your blood sugar is consistently high, you should break your fast to drink water. This is important to keep you hydrated and assist in lowering your sugar levels.
Recognising the danger signs
If you experience any of these symptoms, it is important to test your blood glucose levels immediately and break your fast if necessary. Also inform your friends, family and work colleagues of these warning signs for them to properly assist you if needs be:
Signs of hypoglycaemia (low blood sugar)
- Rapid or increased heart rate
- Shaking or trembling
- Excessive sweating or clamminess
- Blurred vision
- Extreme hunger
- Paleness or loss of colour, particularly in the face
- Slurred, nonsensical speech or strange behaviour
Signs of hyperglycaemia (high blood sugar)
- Frequent urination
- Increased thirst
- Blurred vision
- Dryness in the mouth
- If you are experiencing low blood glucose or prolonged high blood sugar you NEED to break your fast as your wellbeing is at risk. Treat yourself according to the guidelines given by your doctor.
- If you are a family member, friend or colleague of a diabetic who is fasting, seek urgent medical attention if they become unresponsive or refuse to eat or drink. DO NOT administer insulin under any circumstances! If the person is hypoglycaemic, additional insulin will cause their blood glucose to plummet even further and can result in seizures, coma and death.
Find a great brochure on managing diabetes during Ramadan from the Diabetes Federation of Ireland
This article has been reviewed by Cape Town-based endocrinologist Dr. Wayne May in June 2015. Health24 does not endorse diabetics fasting during Ramadan or for any other reason without the approval of an appropriately qualified medical professional.