FASTING WITH DIABETES
With its haleem, biryani and W sheer khurma, Ramzan is also the month of fasting. Of the billion Muslims that observe fasts, a special group of pa tients on whose health, the ritual fast can have a major impact, are people with diabetes.
The most important step in the preparation for a Ramadan fast for those with diabetes is a meticulous diabetic and endocrine assessment two-three months before fasting, fo cusing on low blood sugars, choles terol and blood pressure and in select people, the thyroid hormone levels. Patients should also be informed of the risks of fasting, so that exemp tions can be granted to patients who are not suited to fasting.
Necessary changes in diet and ex ercise regimen should also be initi ated at this point of time including a high fiber low fat diabetic diet and adequate daily exercise, usually for at least half an hour. A structured Ramzan-focused diabetes education programme propagated through mosques and community centres is a good way of driving the message home.
In an observational study by Brav- is et al., patients who fasted during Ramzan without the benefit of a structured educational programme suffered a 400 percent rise in hypo- glycaemic events, whereas those who attended an education programme showed a significant decline in hypo-glycaemic events.
When fasting, a few simple dietary measures can be adopted. These in- clude having fewer simple carbohy drates and fats in the meal, breaking down the evening meal into two-three smaller meals, more intake of fluids at night and taking the pre-dawn meal
recognition of danger signs, choos ing the right meals and also about the need to stop fasting if absolutely required.
Another aspect that is often over looked is weight loss in Ramadan. Most people lose upto two kilos dur ing the Ramadan fast, but regain it within a week after the end of fasting. A structured education programme can help prevent this post-Ramadan weight regain and act as a stepping stone to better health.
as close to sunrise, as is feasible.
Exercise is necessary, but should not be overdone. Excessive exercise in late afternoon can lead to low sugars. Also the physical activity during the prayers should also be added to the quo ta of daily exercise. Almost all the dia-betic medicines can be used during Ramadan. In stead of morning and evening doses, they should be taken before or after iftar and sehar meals. Larger dose reality. of the drug can be taken with the heavier iftar meal. Wherever possi ble drugs that can lower blood sugar levels without causing low sugars (hypoglycemia) must be preferred. But insulin and other oral agents like sulphonylureas can also be used after educating the patients about home monitoring of blood glucose levels,Times are changing, and gone are the days when people with diabetes were barred from Ramadan fasting. With good education, pre-Ramadan assessment, quality endocrine care and the right attitude, a Ramadan fast in most people with Type 2 diabetes is no longer a pipe dream but a
Dr V Sri Nagesh Consultant endocrinologist and diabetologist
INDIAN Thu. 09 June 2016
