Are Religious Fasts Safe for People With Diabetes?

From health.clevelandclinic.org

Planning ahead, checking in with your care team and being vigilant about blood sugar monitoring can help ensure a safe fast 

When you have diabetes, you know you have to keep a careful eye on what you eat and how it impacts your blood sugar. But if you’re part of a faith community that observes religious fasting holidays, you may be left wondering: Can you safely take part, or do you have to sit them out?

“Many people with diabetes are able to fast safely and enjoy the full spiritual, physical and mental health benefits of religious fasts, provided they’re medically cleared and take some necessary precautions,” says endocrinologist Hasan Husni, MD.

Dr. Husni offers wellness tips for fasting holidays and explains why it’s so important to know your blood sugar numbers — plus, how new technology can help.

Is it safe to fast when you have diabetes?

Before you participate in a religious fast, you should talk with your diabetes management team to make sure it’s safe for you to do so.

“During this consultation, your care team can advise you on any medication adjustments, how to monitor your blood sugar levels while you’re fasting, and in which circumstances you may need to break your fast,” Dr. Husni says.

Fasting not only alters the timing of meals, but it can also affect many other elements of your everyday life, including:

• Dietary habits.
• Circadian rhythms.
• Physical activity.
• Sleeping patterns.

“Lifestyle factors like diet, excess weight, smoking and lack of physical activity can all have a negative impact on your blood sugar and insulin levels, which can make diabetes more difficult to manage,” Dr. Husni says.

“A fasting holiday can provide an opportunity to focus on adopting healthy habits that reduce or eliminate these diabetes risk factors, while also reducing cholesterol levels and improving cardiovascular health.”

Plan ahead for fasting holidays by using these five strategies.

1. Be vigilant about monitoring your blood sugar

When you’re fasting, it’s especially important to monitor your blood sugar.

“While you have diabetes and you participate in a fast, you’re at greater risk for the dangers of very high or low blood sugar levels, as well as for dehydration,” Dr. Husni shares.

Another serious complication is diabetes-related ketoacidosis, a life-threatening condition that occurs when your body doesn’t have enough insulin to use sugar for energy. Instead, it breaks down fat, releasing ketones that build up and cause your blood to turn acidic.

To reduce these risks, it’s important to regularly monitor your blood sugar throughout your fast.

“If you want to minimize the need for finger pricking, ask your healthcare provider about continuous glucose monitoring,” Dr. Husni suggests. “This is a small, temporary and wearable device that measures glucose levels 24 hours a day. You typically replace it every 10 to 14 days, or as needed.”

2. Recognise warning signs

In addition to monitoring your blood sugar, check in with yourself throughout your fast — and be sure you know the warning signs of high or low blood sugar so that you know if you’re experiencing a medical emergency that will require you to break your fast.

Some of the most common signs of low blood sugar (hypoglycaemia) are:

• Shakiness or trembling.
• Weakness.
• Sweating and/or chills.
• Feeling extremely hungry.
• Sped-up heart rate.
• Dizziness or light-headedness.
• Confusion or trouble concentrating.
• Anxiety or irritability.
• Colour draining from your skin.
• Tingling or numbness in your lips, tongue or cheeks.

Symptoms of high blood sugar (hyperglycaemia) include:

• Blurred vision.
• Frequent urination.
• Headache.
• Increased thirst and/or hunger.

“If you start to experience any of these symptoms, test your blood sugar immediately,” Dr. Husni advises. “In general, you’ll need to break your fast if your blood glucose is lower than 70 mg/dl (3.9 mmol/l) or higher than 300 mg/dl (16.7 mmol/l).”

Some people, he notes, may need to break their fast at different blood glucose levels depending on their age and overall health, so it’s important to discuss this ahead of time with your diabetes management team.

3. Break your fast carefully

It’s always best to break your fast with a healthy meal that will help hydrate you and restore your strength. And it’s important not to gobble it down.

“It can be challenging to resist the temptation to have a very large meal at iftar. Additionally, people often break their fasts by eating quickly, which can lead to overeating,” Dr. Husni says. “It takes 15 to 30 minutes for the satiety signal to reach the brain.” This can make it difficult to tell when you're full.

Plus, he adds that some people actually gain weight during long-term fasting holidays like Ramadan, as a result of factors like being less active, eating carb-heavy foods at iftar and snacking throughout non-fasting hours.

If you have diabetes and are observing Ramadan, consider working with a nutritionist who’s experienced in diabetes education.

“They’ll determine your daily calorie needs for weight loss or weight maintenance, whichever the case may be,” Dr. Husni says, “and they can help you create a sustainable meal plan or strategy that ensures that you’re getting the correct balance of macronutrients, including proteins, fats and carbohydrates, at suhoor and iftar.”

Generally, he recommends consuming around 40% to 50% of your daily calorie intake at iftar; around 30% to 40% at suhoor; and the remainder as a snack at night.

4. Stay hydrated during non-fasting hours

Dehydration is a major risk during fasting holidays, especially if you’re doing a dry fast that doesn’t allow you to drink water.

“It’s important to drink adequate amounts of water during non-fasting hours and to limit your intake of caffeine-based or sugary drinks,” Dr. Husni stresses. “This is especially true in areas with hot climates or long daylight hours, where the risk of dehydration and diabetes-related ketoacidosis is greater.”

5. Get some exercise

In general, physical activity brings all kinds of benefits, including helping regulate blood sugar, weight management and supporting cardiovascular health. But when you have diabetes, it’s best to talk to your healthcare provider ahead of time about exercising during a religious fast.

“Exercise should only be undertaken carefully, particularly if you take insulin,” he says, “because it can put you at a higher risk of having low blood sugar when you exercise.”

It’s best to stick to low- to- moderate-intensity physical activity rather than going all-out with a hardcore sweat session.

“During Ramadan, for example, we generally recommend walking as a safe way to exercise, preferably after iftar,” he adds.

Diabetes doesn’t necessarily require you to skip your fast

While some people with diabetes seek a religious exemption from fasting, many can safely participate. It should always be a shared decision between you, your physician and your religious leader.

From a medical perspective, Dr. Husni emphasizes checking in with your diabetes care team ahead of time to be sure you’re approaching fasting in the healthiest way possible.

“Religious fasting holidays, especially longer-term ones like Ramadan, can be a wonderful time to embrace healthy habits that you can build on once the fasting period is finished for long-term health benefits,” he says.

https://health.clevelandclinic.org/fasting-and-diabetes

Mayo Clinic Q and A: Diabetes and fasting during Ramadan

From newsnetwork.mayoclinic.org

DEAR MAYO CLINIC: Our family observes Ramadan, but my father was recently diagnosed with diabetes. He is very spiritual and would like to continue to fast during the month of Ramadan, but I don't think it's wise. Can you share whether he can safely fast or if he should avoid this practice due to his condition?

ANSWER: When you have diabetes, your diet is a vital part of your treatment plan. Patients with diabetes need to be more mindful about the foods they eat, and the details, such as calories, total carbohydrates, fibre, fat, salt and sugar. All of these could have the potential to affect their blood sugar levels.

While some people choose to not eat for a period of time, or fast, for religious reasons, such as from dawn to sunset during the Islamic holy month of Ramadan, fasting is something that your father should not do without advance planning. I would recommend that you and your father talk with his health care provider about the specifics of his health and the details surrounding his desired fast.

There are potential risks of complications from fasting, such as low or high blood sugar and dehydration. Typically, a person with Type 2 diabetes that is well-controlled, who manages their diabetes with medications and lifestyles, may be OK fasting during Ramadan, so long as they can adjust their medications under the guidance of their care team.

However, there are individuals who may be at high risk of complications if they fast during Ramadan. These individuals would be those who have one or more of the following:

• Type 1 diabetes
• Type 2 diabetes with poor blood sugar control or taking certain types of insulin
• Recent history of severe low blood sugar or diabetic ketoacidosis
• History of recurring low blood sugar or unawareness of low blood sugar
• Conditions such as severe kidney disease or blood vessel complications
• Diabetes and are pregnant

Your father's health care provider may suggest that he avoid fasting all together if he is at high risk of complications. If the decision is made to fast, your father's health care provider and diabetes care team likely will provide you with education about managing his diabetes and adjusting medications or insulin doses while fasting.

The most important thing to remember if your father plans to fast during Ramadan is that he will need to monitor his blood sugar closely, and family members will need to be mindful of signs of low blood sugar, including:

• An irregular or fast heartbeat
• Fatigue
• Pale skin
• Shakiness
• Anxiety
• Sweating
• Hunger
• Irritability
• Tingling or numbness of the lips, tongue or cheek

As low blood sugar worsens, signs and symptoms can include:

• Confusion, abnormal behaviour or both, such as the inability to complete routine tasks
• Visual disturbances, such as blurred vision
• Seizures
• Loss of consciousness

Low blood sugar, also called hypoglycaemia, needs immediate treatment. For many people, a fasting blood sugar of 70 milligrams per decilitre (mg/dL), or 3.9 millimoles per litre (mmol/L), or below should serve as an alert for hypoglycaemia. But your father's numbers might be different, so it will be important to have a conversation with him and his health care provider to know what number is too low for him.

Likewise, high blood sugar is something that needs to be watched. Additionally, your father will need to follow his health care provider's advice and suggestions regarding specific food, drink and exercise during the month. He should be prepared to adjust his medication doses as appropriate, and, most importantly, be ready to stop fasting if there is an issue.

Fasting during Ramadan can be done safely as long as you and your father take time to understand the risks, identify the best way to help him manage his care and carefully follow the care team's recommendations. ― Dr. M. Regina Castro, Endocrinology, Mayo Clinic, Rochester, Minnesota

https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-diabetes-and-fasting-during-ramadan/

Healthy Ramadan meals for people with diabetes

From gulftoday.ae/news

People with diabetes may still fast during the Holy Month of Ramadan with proper consultation and guidance with their diabetologists and/or endocrinologists.

This is to prevent four acute conditions brought about by “metabolic consequences of prolonged fasting combined with dietary changes and alterations to the dosage and timing of the medications,” Al Zahra Hospital-Dubai Endocrinology & Diabetes specialist Dr. Vikram Hundia said in an interview on Wednesday.

Hundia identified the complications as hyperglycaemia (high blood sugars), hypoglycaemia (mildly low blood sugars), severe hypoglycaemia, and diabetic ketoacidosis (characterized by the insufficient amount of insulin to produce glucose and a warning sign that the diabetes is getting out of control and may lead to body poisoning).

“It is never too late to consult with your doctor on what to do and not to do for the rest of the Holy Month of Ramadan. But make a clear written plan with your Diabetes Team about any changes to your insulin or diabetes medication dosage and timing to maintain satisfactory diabetes control and avoid hypoglycaemia or other diabetes-related complications,” he said.

Hundia added: “Check your blood sugar levels more frequently. Drink plenty of sugar-free fluids during the non-fasting times to avoid dehydration. Avoid caffeine.”

He emphasized the role of the dietician.

                                               Photo has been used for illustrative purpose.

Hundia’s colleague, Reshma Devjani was interviewed as well and while she offered healthy tips too, she also spent time dishing out menu samples for the diabetics.

Devjani pointed out seven causes why people with diabetes suffer from poor glucose control during the Holy Month of Ramadan, leading to the shoot up and/or prolonged high blood glucose levels and weight gain.

These are large meals particularly at Iftar; indulgence in processed food and refined carbohydrates; excessive consumption of empty caloric food namely dates, juices, colas, and sugary desserts; frequent snacking and inadequate meal spacing; fast-pace eating the consequence of which is over-eating; irregular blood glucose monitoring; skipping of medications, mismatching of medications or insulin to the altered “me timings.”

“Remember to keep meal portions in moderation. Choose to eat whole grains and seeds like barley, millets, oats, semolina, quinoa, wild rice, beans and lentils,” Devjani said.

Devjani’s meal sample for people with diabetes who fast during this Holy Month of Ramadan:

Iftar: one to two small dates plus one to two glasses of water; one cup of Tabbouleh Salad; 90 to 120 grams of Chicken cooked in Curry Sauce; one cup of Steamed Wild Rice; one cup of Low Fat Greek Yoghurt; and two glasses of water.

First Snack: one Baked Apple topped with Cinnamon plus 10 to 15 Walnut Halves and two glasses of water.

Second Snack: two to three tablespoons of Hummus Dip with Carrot/Cucumber/Celery Sticks as desired plus one cup of Laban and two glasses of water.

Suhour: two slices of Whole Grain Bread, Omelette with Grilled/Sautéed Vegetables on the side, one tablespoon of Peanut Butter or 30 grams of Avocado, one cup of Low Fat Greek Yoghurt or Laban, one-half cup of Strawberries, and two glasses of water.

For Ramadan Day 2:

Iftar: one to two dates plus one to two glasses of water, one cup of Homemade Lentil Soup, one cup of Green Salad topped with Lemon Dressing, 90 to 120 grams of Lean Meat, one cup of Cooked Quinoa, one cup of Low Fat Greek Yoghurt.

First Snack: one cup of Berries topped with two to three tablespoons of Low Fat Greek Yoghurt garnished with two tablespoons of Crushed Walnuts and Pumpkin Seeds and two glasses of water.

Second Snack: two Oven-Baked Chicken Spring Roll with one tablespoon Guacamole Dip plus one cup of Homemade Pumpkin Soup and two glasses of water.

Suhour: one Small Four-Inch Brown Pita Bread, one cup of Cooked Foul, two tablespoons of Low Fat Labneh with Zaatar plus three to four Olives, one cup of Low Fat Greek Yoghurt or Laban, one Small Plum and two glasses of water.

https://www.gulftoday.ae/news/2020/04/29/healthy-ramadan-meals-for-people-with-diabetes