Interviews with senior diabetologists brought to light some important steps to help diabetic patients who want to fast without experiencing medical complications.
Prof M. Zaman Shaikh, the director of the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, told Dawn that the frequency of acute complications was higher in the patients with type-1 and type-2 diabetes who fasted.
He said patients with severe hypoglycemia (very low blood sugar), severe hyperglycemia (very high blood sugar), type-I diabetics who are always on minimum two doses of insulin a day, patients with acute illness, on dialysis, liver and kidney impairment, elderly patients especially living alone and pregnant women must see their doctor before deciding to fast during Ramazan.
Speaking of the complications, the professor said that hyperglycemia which caused drowsiness, perspiration, palpitation, increased hunger and restlessness, dehydration, and blood clotting were some major risks.
Regular blood sugar monitoring and meal planning were the basic guidelines to avoid such complications, he said.
Besides, he suggested that such patients wear medical alert bracelets or keep a card in their pocket with the mention of their own and their doctor’s name, address and phone numbers, especially if they are on insulin or on high potency drugs.
He said that blood sugar should be monitored just before and two hours after Iftar and Sehri. From Sehar to Iftar, at any given time, blood sugar should not be below 100mg/dl and above 200mg/dl.
If blood sugar was less than 80mg/dl in the morning, diabetics should contact their doctors or break their fast, he said.
About the meal management, he said that patients should increase intake of fluid and complex carbohydrates and avoid food rich in fats and sugar. They should take Sehri as late as possible and should avoid dates, juices and other traditional food items at Sehri and Iftari which are rich in cholesterol and sugar.
He advised patients to break their fast any time during the day if their blood sugar level was less than 60 mg/dl and to avoid fasting when they are sick. He said that those diabetic patients who controlled their blood sugar on diet and oral drugs could safely fast but after advice of their physician regarding modifications in the timings of exercise and dosage of their drugs.
“Patients who are on insulin once or twice a day should get advice from their doctors for change in type and dose of insulin if they insist on keeping fast,” he added.
He said that these patients should also take care of their blood pressure which tends to fall during fasting and their blood cholesterol which tends to increase during Ramazan because of unhealthy eating habits.
Prof Asmat Nawaz of the Baqai Institute of Diabetology & Endocrinology said that type-1 diabetes was not an absolute contraindication for fasting and many people with type-1 diabetes could fast under the supervision of their physicians. “With the timely and appropriate medical guidance, fasting in Ramazan for diabetics could be as pleasant as for non-diabetics,” he remarked.
However, according to him, fasting involves risk for people whose diabetes is not well under control; who have very low or very high blood sugars in last three months; who have developed nephropathy (kidney disease), retinopathy (eye disease) or neuropathy (nerve disease) as a complication of diabetes; who are undergoing dialysis for kidney failure; who suffer from a severe illness in the last few weeks; and elderly diabetics with a poor general health.
He said that hypoglycemia (low blood sugar) is the most apprehended adverse event occurring during fasting, particularly in type-1 diabetics and type-2 diabetics who are taking insulin.
“Low blood sugar can ef fectively be prevented by prior adjustment of the dosage and timings of insulin or diabetes tablets and by a comprehensive dietary advice,” he said adding that the hyperglycemia (high blood sugar) is another possible complication.
He further said that diabetics should avoid physical exercise till Iftar.
According to Dr Nawaz, diabetics should take a balanced diet containing carbohydrates, proteins and some amount of fats in Sehri.
“Although diabetics are advised to avoid paratha normally, a paratha with moderate amount of canola oil or olive oil (instead of plain chapatti) is advisable in Sehri which helps prevent low blood sugar during the day,” he added.
He said that protein requirements could be met by taking egg white or fish and chicken. Foods containing dietary fibre must be taken at Sehri as fibre helps maintain blood sugar at the normal level, the doctor said
