Diabetes During Ramadan
diabetes-in-ramadan

What is diabetes?

Diabetes is the condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either does not make enough insulin or cannot use its own insulin as well as it should.

There are two main types of diabetes:

  • Type 1 diabetes, previously called insulin-dependent diabetes mellitus (IDDM) or juvenile onset diabetes, usually diagnosed before the age of 30. In this type, the pancreas produces little or no insulin.
  • Type 2 diabetes, was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, Risk factors for Type 2 diabetes include older age (Usually diagnosed after the age of 40), obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity. In this type, the insulin either produced in insufficient amounts and/or cannot be used by the body to control blood sugar levels.

Other specific types of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

What are the symptoms of diabetes?

People who think they might have diabetes must visit a physician for diagnosis. They might have some of the following symptoms:

  • Frequent urination
  • Excessive thirst
  • Weight loss
  • Extreme hunger
  • Blurry vision
  • Extreme fatigue
  • Tingling, pain, or numbness in the hands/feet

What Risks Should I Be Aware Of In Ramadan?

  • Not eating when taking insulin or certain other diabetes medications can raise the risk of hypoglycemia.
  • Low blood glucose (or hypoglycemia)
    Fasting can precipitate hypoglycemia due to a reduction in oral intake. The risk of blood glucose levels going too low is highest in people taking insulin or certain diabetes pills.
  • High blood glucose (or hyperglycemia)
    Hyperglycemia is one of the most common problems observed during this month; a fear of hypoglycemia patients, coupled with carbohydrate and calorie rich meals, associated with an abrupt change in mealtimes contributes to this hyperglycemia.
  • Dehydration
    Multiple factors are responsible for dehydration during fasting, including a restriction on fluid intake while fasting, osmotic diuresis due to hyperglycemia, fasting during summer, and increased physical activity and associated sweating. Dehydration, especially when severe, can manifest as postural dizziness; orthostatic hypotension leading to falls and fractures, especially in the older people; and the most dreaded complication of thrombosis. Dehydration precipitates a hypercoagulable state due to contraction of intravascular volume and increase in the viscosity of blood. Diabetes itself is a prothrombotic state due to decreased fibrinolysis and endogenous anticoagulants and the rise in a few clotting factors. This thrombotic state can manifest as a cerebrovascular accident, myocardial infarction, or even as retinal vein occlusion. If your urine becomes dark, that is a sign you are dehydrated. Severe headache, nausea, and vomiting would all be signs that you would want to break your fast.
  • Diabetic ketoacidosis
    When the body’s cells do not get enough glucose, it starts to burn fat for energy. When the body burns fat instead of glucose it causes waste products called ketones. Patients with type 1 diabetes, who choose to fast during Ramadan, are at a higher risk of developing ketoacidosis, especially if they have been experiencing hyperglycemia frequently before Ramadan. This is plausible in the setting of pre-fast poor control and compliance, carbohydrate rich meals, the tendency to reduce insulin doses for fear of hypoglycemia, and in the setting of infection.

Lifestyle changing

Check with the doctor before Ramadan to determine the ability of the diabetic to fast, and modify the treatment and doses accordingly.

  • Adhering to the suhoor and delaying it as soon as possible before the dawn athaan, in order to avoid the fall of sugar.
    Do not exercise during the day, especially in the last remaining hours of fasting to avoid falling sugar. Limit physical activity during fasting hours and be more active after iftar.
  • Do not over-eat foods and sugars at breakfast hours; to avoid high blood sugar level.
  • The patient should monitor blood sugar level before breakfast and 2-3 hours later. The sugar level should be monitored before suhoor to adjust the insulin dose and prevent hypoglycemia or hyperglycemia.

References:

"Diabetes." Recommendations for Management of Diabetes During Ramadan,
TCS Wellness Program