DIABETES CONTROL DURING RAMADAN FASTING

Abdul Hamid Zargar, MBBS, M.D., D.M.

Raveendran A.V., MBBS., M.D.

(Synopsized and excerpted from an article in Cleveland Clinic Journal of Medicine)

An estimated 50 million patients with diabetes worldwide practice daily fasting during Ramadan. According to the “Multi-Country Retrospective Observational Study of the Management and Outcome of Patients with Diabetes During Ramadan”, conducted in 13 countries, 94.2% of Muslim diabetic patients fasted at least 15 days and 67.6% of these fasted every day.

The goal of caring for diabetic patients during Ramadan is to:

Help them fast without major complications.
Empower them to modify their lifestyle in order to achieve their goal or fasting. Diabetic patients could encounter the following possible complications during fasting.

1. HYPOGLYCEMIA: Decrease in blood glucose level that could possibly be dangerously low it cause serious complications. The risk is 4.7 times and 7.5 times for type 1 and type 2 diabetes respectively.

2. HYPERGLYCEMIA: Increase in blood glucose level way beyond normal range that could cause symptoms and other metabolic complications. The risk is 3.2 times and 5 times for type 1 and type 2 diabetes, respectively.

3. DEHYDRATION & CLOT FORMATION: Patients can become deficient in water content of the body by poor intake due to fasting and loss of water from body due to increased blood glucose levels. Diabetes by itself is a condition prone to develop clot in the blood, the dehydration can increase this risk further.

Following recommendations from those who have diabetes and intend to fast in Ramadan, are scientifically based and should be carefully followed;

People with diabetes, by experience know very well when their blood sugar is dropping and causing the level to become abnormally low. At anytime during the fast if signs and symptoms of low blood sugar are experienced, be prepared to break the fast without any inhibition based on religion.
People should monitor blood glucose-levels at least twice daily before suhoor and before Iftar, so that the dose of medicine and the diet may be adjusted for the day. If anybody says it is haram to spill drops of blood while fasting for testing, just ignore such nonsense.
Setup a special appointment with your doctor before that start of Ramadan to discuss thoroughly your plan to fast and understand the changes in the dosage of the medicine and their timings as recommended by the doctor. There are certain medicines known to your doctor which carry a low risk of abnormal drops in blood glucose levels. They are preferable in Ramadan. Insulin in general and specially of 70:30 combination are associated with higher risk of hypoglycemia (excessive drop in the blood glucose). If you are able to manage your insulin dose based on your blood glucose levels (sliding scale dose regimen), reduce the dose of basal insulin called lantus or Levemir and add a short-acting insulin dose before suhoor and before Iftar based upon blood glucose levels. Trying to manage your diabetes through short-rating insulin is preferable and safe.
Don’t miss suhoor and maintain a balanced diet. Complex carbohydrates that release energy slowly during the day are suitable for predawn meal while simple carbohydrates are good for Iftar and dinner. Avoid fatty and fried foods. Have a jugfull of water by your bedside when you sleep and frequently drink it in the night and at predawn mean to avoid dehydration in the day.
The physical activity level should be mild to moderate as tolerated. Should avoid excessive or vigorous activity especially toward evening hours to prevent hypoglycemia.

If you are able to avoid hypoglycemia (excessive drop in blood glucose level), fasting in Ramadan may be accomplished without much hardship and in a way will have a beneficial effect on body by helping you lose weight. Fasting could be a blessing especially for obese persons, for overweight has a direct deleterious effect on diabetes and its management.

AFTER VACCINATION?

With millions of Americans at least partly immunized against the coronavirus, and millions more joining the ranks every day, the urgent question on many minds is: When can I throw away my mask? It’s a deeper question than it seems — about a return to normalcy, about how soon vaccinated Americans can hug loved ones, get together with friends, and go to concerts, shopping malls and restaurants without feeling threatened by the coronavirus.

Certainly many state officials are ready. On Tuesday, Texas lifted its mask mandate, along with all restrictions on businesses, and Mississippi quickly followed suit. Governors in both states cited declining infection rates and rising numbers of citizens getting vaccinated.

But the pandemic is not yet over, and scientists are counseling patience.

It seems clear that small groups of vaccinated people can get together without much worry about infecting one another. The Centers for Disease Control and Prevention is expected shortly to issue new guidelines that will touch on small gatherings of vaccinated Americans.

Don’t think that modern medicine is skeptical of natural medicine and healing. At Harvard Medical School, more and more clinical studies have focused on these topics. The following conclusions are the result of such studies coming from them:

Taking vitamin C doesn’t help reduce the number of colds you get, but taking it every day may help reduce the length of a cold.
Roll back 10 years off your heart’s “odometer” simply by eating fewer calories
Lack of one key vitamins seems to play an important role in psoriasis.
Simple home remedy for snoring: Change your sleep position! Sleeping on your back makes it worse; sleeping on your stomach makes it stop.
Dry eyes? Drink a cup of coffee! New research shows that people who consume caffeine produce more tears than people who don’t