GK: Is fasting doable for a diabetic?
Prof Laway: Fasting throughout the holy month of Ramadan varieties one of many 5 pillars of the Muslim religion. Throughout the Muslim neighborhood, there may be an intense want to take part in fasting, even amongst those that are eligible for exemption.
The period of fasting is over 14 hours throughout the month of April and Could and days could be starting from heat to sizzling. Roughly 50 million Muslim adults with diabetes go with out meals or drink from dawn to sundown throughout the month of Ramadan, regardless of having a spiritual exemption.For a lot of Muslim individuals with diabetes, Ramadan is a spiritual conviction and the intermittent fasting is a key part of its observance. In sufferers with diabetes, fasting can generally be detrimental.
GK: What are the dangers related to fasting?
Prof Laway: Dangers related to fasting stem each from daytimerestriction on consuming and nighttime indulgent consuming and feasting, these along with sizzling and humid situations make many problems extra seemingly. The dangers of fasting to sufferers with diabetes embody: low blood glucose, excessive blood glucose and dehydration.There is also an elevated threat of clotting of blood within the vessels(due to dehydration and excessive blood glucose).Retaining these problems and steadiness of spiritual sentiments in thoughts, consultants have advisable some pointers for the physicians, sufferers and their caregivers.
GK: Amongst diabetics, who can quick safely?
Prof Laway: In keeping with these pointers, following group of sufferers can safely quick throughout Ramadan:
These with well-controlled diabetes handled with a number of of the next: life-style remedy, metformin, acarbose, thiazolidinediones, second-generation sulfonylureas (like glipizide, glimpiride and gliclazide), incretin-based remedy (DPP-4 inhibitors or GLP-1 RAs), SGLT2 inhibitors, and basal insulin. To hold on fasting safely, this group of sufferers additionally ought to take recommendation from the doctor and monitor blood glucose regularly.
GK: Who mustn’t quick then?
Prof Laway: Due to excessive threat of deadly problems throughout fasting, a affected person with diabetes with a number of of the next mustn’t quick:
- Sort 1 diabetes
- Poor blood sugar management (HbA1c of > 8.5%)
- Historical past of ketoacidosis throughout 3 months earlier than Ramadan
- Very excessive blood glucose throughout 3 months earlier than Ramadan
- Superior coronary heart, liver and kidney illness
- Cognitive dysfunction, epilepsy
- Recurrent hypoglycemias (episodes of low blood glucose)
- Extreme hypoglycemia(low blood glucose needing help of one other particular person to deal with) in final 3 months earlier than Ramadan
- Affected person getting low blood glucose with out signs
- Pregnant ladies
- Acute sickness together with diabetic foot or foot ulcer
- Folks taking intense bodily labor
GK: What’s your food plan recommendation for sufferers throughout Ramadan?
Prof Laway: Folks tend to overeat throughout Ramadan and food plan is often wealthy in carbohydrate and fats leading to uncontrolled diabetes. Due to concern of hypoglycemia, individuals are inclined to overeat throughout suhur additionally. Blood glucose management may additionally be disturbed due to iftar events.
A wholesome balanced food plan and distribution of energy into 2-3 servings throughout non fasting hours helps in command of diabetes. Pre daybreak meal (suhur) ought to primarily comprise meals wealthy in complicated carbohydrates like entire grain cereals, greens corresponding to beans and lentils and fruits. Consuming dates historically marks the tip of a quick however are very wealthy in sugars; a portion of 1-2 dates might nevertheless increase blood glucose.
Dinner needs to be taken as early as doable after iftar and will primarily include a mixture of entire wheat flour chapattis, greens and small quantity of meat, salads needs to be taken to extend the fibre content material. A late evening snack with a glass of milkor a portion of fruit will keep a standard blood glucose until suhur time. Non caloric fluid consumption ought to beincreased throughout non fasting hours.Keep away from caffeine- based mostly drinks corresponding to tea, espresso and cola. Caffeine ends in extreme urination and therefore ends in water loss from the physique.
GK: What about train and Taraweeh prayers throughout Fasting?
Prof Laway: Gentle and average train is protected. Rigorous train will not be advisable as this will increase the danger of hypoglycemia (falling glucose stage) particularly if on insulin or oral medication. Taraweeh prayers and strolling to the mosque needs to be accounted for within the train routine. People ought to carry water and fast performing carbohydrate drink (for correction of hypoglycemia in case such a factor occurs). It’s higher to go for an train like every day stroll after suhar or iftar. An individual going for Taraweeh prayers doesn’t must go for an everyday stroll
GK: How does one monitor blood glucose throughout fasting?
Prof Laway: First, blood glucose monitoring throughout fasting doesn’t break the quick. Due to this fact, monitor blood glucose ranges at first of the quick at mid day and earlier than iftar. Blood glucose ranges needs to be checked if any signs of hypoglycemia (low blood glucose) corresponding to elevated urge for food, sweating, nervousness or any disagreeable feeling or if the affected person turns into unwell.
GK: When does a affected person want to finish fasting?
Prof Laway: At any level the affected person feels unwell, fasting needs to be terminated. The next indicators needs to be saved as pointers:
- Blood glucose ranges are 75mgs/dl at any time throughout the quick
- Blood glucose ranges > 300mgs/dl any time throughout the quick
- Signs of hypoglycemia(like elevated urge for food, sweating, nervousness or any disagreeable feeling) even when blood glucose stage is regular
- Affected person feels unwell
GK: Are any adjustments in medicines advisable throughout Ramadan?
Prof Laway: Greatest, talk about along with your physician. The final guidelines:
- For sufferers taking Metformin, Pioglitazone, Gliptins, Acarbose, Voglibose, SGLT2 inhibitors and GLP1 receptor agonists, no change in treatment required
- As soon as a day sulfonylureas dose is to be taken after iftar
- Twice a day sulfonylureas: Morning dose to be halved and brought with Suhur, night dose stays similar
- Basal insulins like NPH, glargine(lantus,baselog,basugine, glaritus), degludec (tresiba) : scale back every day dose by 20% and provides at mattress time
- Insulin 30/70, twice every day or Humalog combine/Novomix twice every day: Morning dose to be taken after iftar, night dose to be diminished by half and brought earlier than Suhur
GK: Your summarized recommendation?
Prof Laway: Regardless of intense want to quick, a pre Ramadan recommendation needs to be taken from a doctor concerning its related dangers. Expertise from the earlier Ramadan can act as a information within the present month; specific consideration needs to be paid at food plan, train, glucose monitoring and avoidance of hypoglycemia.
Prof Bashir Ahmad Laway is head Division of Endocrinology at SKIMS Soura. He will be mailed at [email protected]