Ramadan, the fasting month, is a significant time for Muslims worldwide. During this time, Muslims refrain from eating or drinking from sunrise to sunset. However, for those with diabetes, fasting can pose challenges that require careful management. Failure to manage diabetes during Ramadan can lead to various health complications. In this article, we will discuss some practical tips and strategies that can help individuals with diabetes maintain their health during the month of Ramadan while also observing their religious duties.
So what is Ramadan?
Ramadan is one of the holiest months in the Islamic year. Fasting in the holy month of Ramadan is one of the five pillars of Islam and is considered compulsory for all healthy adult Muslims. The fast lasts between dawn and sunset, meaning that Muslims abstain from eating or drinking for the duration of their fast (i.e. all daylight hours). However, fasting when you have got diabetes, especially for such long periods, can be dangerous and can cause problems for your health.
So, what happens to your body when you fast?
When you are fasting, approximately eight hours after your last meal, your body starts to use its own energy stores to help keep its blood glucose levels normal. It does this by breaking down your liver glycogen stores, and stored fats and proteins. These all break down into glucose and are released back into the bloodstream to increase your blood glucose levels to normal.
These different processes allow the body to maintain a lower, but significant level of glucose, despite fasting. For most people, this is not harmful. However, if you have diabetes, the normal mechanisms of maintaining BGLs during fasting may be altered. This can be affected further, especially if you take certain tablets or insulin. You are therefore at higher risk of hypoglycemia (or hypos) which is when your BGLs are too low.
With this year’s fast lasting up to 16 hours, the risks of hypos and dehydration occurring are high. The other thing that can happen when you are fasting, is the risk of hyperglycemia or high BGLs after Suhoor (Sehri) and Iftar. This is because often larger meals are eaten before and after fasting and can lead to the release of lots of glucose into the bloodstream.
Should you fast in Ramadan if you have diabetes?
Choosing to fast is a very personal decision. Islam does say that people with certain health conditions like diabetes are exempt from fasting, especially if they use insulin or certain other medications. This also includes pregnant women with diabetes.
As discussed earlier, there is a risk of hypos, high BGLs, and dehydration during fasting. Additionally, for some people with diabetes, fasting can be dangerous or cause problems to their health. Particularly:
• If you have poorly controlled diabetes
• Have a recent history of diabetic ketoacidosis or DKA
• Or, have complications caused by diabetes including CKD, foot infection
If you still do want to fast. it is important that you adequately prepare for Ramadan by discussing your diabetes with your GP or diabetes team, ideally 6-8 weeks before Ramadan begins. This is so that they can help you decide if it’s safe to fast and help you prepare and manage your diabetes throughout Ramadan.
What about testing your blood during the fast? For those of you who have been provided a meter by your GP or diabetes team. It’s really important to regularly test your blood glucose levels during the fast so you can check you are keeping safe. Testing your BGLs will not break your fast. Writing down your BGLs can help your diabetes team to make decisions about your diabetes treatment.
The changes in lifestyle and eating patterns during Ramadan place patients with diabetes at risk of hypos during the day and high BGLs at night. The types of diabetes medication you normally take can also impact on this risk.
Therefore, whatever type of diabetes you have (can you pop this up T1, T2, gestational). A pre-Ramadan assessment is vital if you plan to fast. We strongly recommend you always speak to your GP or diabetes team in order for them to produce an individual treatment plan (ie: help make changes to your medications) to help keep you safe throughout Ramadan. If you have type 1 diabetes or are pregnant and have diabetes – you may need close medical supervision from your diabetes team to fast safely. After Ramadan, you may need further follow-up with your GP or diabetes team to re-assess your medications.
Foods that will your diabetes at Suhoor
So the next question is What type of foods will help your diabetes at Suhoor?
• Firstly, it is important to make sure you actually wake up to eat a meal at Suhoor
• It will be easier to manage your blood glucose levels through the fast if you eat just before dawn instead of at midnight. As. long hours without eating can increase your risk of hypos.
• Try to eat starchy carbohydrates which release energy slowly, for example – low GI foods. These will help keep your BGLs more stable throughout the fast.
Lower Gi food includes foods such as porridge, wholegrain cereals, wholegrain/seeded bread, or basmati rice. Other foods include pitta bread, chapattis or injera, or semolina.
• Try to include more protein foods such as eggs, beans, and nuts as these will not impact your BGLs and is absorbed more slowly.
• Mixing fruit with Greek-style yoghurt can help reduce the GI of the fruit.
• Lower GI foods are often higher in fiber too which can be helpful to avoid constipation.
Types of foods to eat at iftar
Ramadan is about self-control and discipline. Try to eat sensibly and healthily. Eating too much-fried foods and foods high in fat and sugar will make you put on weight and raise your BGL and make them more difficult to control. Try to eat moderate portion sizes.
• You can still eat dates but aim to have only a small portion – (a portion is 2-3 dates)
• Try to only have 1 moderate portion of starchy carbohydrates such as bread, potatoes, sweet potatoes, wholegrain couscous, noodles, or pasta. Having more than 1 portion or large portions it can lead to higher BGLs. Chapatti, injera, wrap, pitta, fufu, plantain or yam. Include lean protein foods such as chicken, meat, fish, beans, eggs, or low-fat cheese.
• Include some dairy foods to help ensure you have an adequate calcium intake – use low-fat milk or yoghurts to make milky drinks or smoothies with vegetables or a handful of berries
• Including fruit, vegetables or salads throughout the evening will help achieve a good vitamin and mineral intake.
• Try to use small amounts of olive oil, vegetable oil, or blended oil. Oily fish (e.g. tuna, sardines, salmon) are a good source of healthy fats (omega-3 fatty acids)
What about snacks? Consider spacing your meal out so you have a moderately sized meal at Iftar and then 1-2 small snacks before going to bed – where again you are better having slow-releasing carbs or low-carbohydrate foods, instead of sugary desserts which will increase your BGLs. Examples of no-carb foods include:
• A handful of nuts • 1-2 boiled eggs or a small omelet
• Vegetable sticks with 2-3tbspns of hummus/salsa/low-fat cheese spread
• ½ Avocado Examples of low carbs foods include:
• 1 portion of fruit with Greek-style low-fat yoghurts
• Wholegrain bread sandwich with cheese or chicken
• ½ injera with lentil soup
And there are another thing that we should keep in mind is “portion“. A rough guideline is:
• Carbohydrates: the size of your clenched fist
• Fruit – 1 handful • Protein: for meat/chicken/fish the size
of your palm. For dairy, a portion of milk is a small glass, and yoghurt is 1 small pot.
Fluids and drinks
Fasting can put you at risk of dehydration with long hours of fasting as can having high blood glucose levels. Adults often need between 1.5 – 3L of fluid each day. You may need more in warmer climates or if you have increased losses through sweating. It is best to avoid adding sugar to your drinks or having sugary drinks such as fruit juice or full-sugar fizzy drinks.
Instead, try to drink plenty of water or sugar-free drinks at Suhoor and after Iftar. Remember milk, yoghurts, soups, salad, or watery fruits all count towards fluid. Try not to drink too many cups of tea or coffee as they can act as diuretics and can increase the risk of dehydration. An example of a Ramadan plate looks something like this.
Exercise and fasting
Can you exercise or pray Taraweeh? Intense or rigorous exercise is not recommended during fasting because in can increase your risk of hypos and increase the risk of dehydration. Light-to-moderate exercise that you may normally do should be ok during fasting.
Taraweeh can be a moderately active exercise due to the bowing, kneeling, and rising for a considerable amount of time. It can increase your risk of dehydration and risk of hypos. It may be beneficial to take water and hypo treatment with you to Taraweeh. Try to drink water after Taraweeh too.
In conclusion, managing diabetes during Ramadan requires careful planning, discipline, and monitoring. It’s crucial to consult with your healthcare provider and develop a personalized plan that considers your unique health needs and lifestyle. With the right strategies and mindset, it’s possible to have a safe and healthy Ramadan while effectively managing your diabetes. Remember to stay hydrated, choose nutrient-dense foods, and engage in moderate physical activity. By following these tips and being mindful of your health, you can enjoy a fulfilling and spiritually enriching Ramadan.
If you like this article then don’t forget to check our other articles about maintaining diabeties.
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