Nutrition

Fasting and Diabetes – is it safe?

By Erika Chan
Dietetic Intern

This month, over 1.5 billion Muslims will be practicing the holiday known as Ramadan. Ramadan occurs during the 9th month of the Islamic lunar calendar. This year, the religious holiday started on Saturday, June 28, 2014 and will continue until the evening of Monday, July 28, 2014. The holiday is dedicated to purifying the soul, focusing attention on God, and practicing self-sacrifice and discipline – which includes fasting from sunrise until sundown throughout the religious holiday.

If you have diabetes, Ramadan requires balancing your religious obligations with practices that will keep your body healthy and happy. You can rest assured that there is a safe way to observe this holy holiday even with diabetes, but you should be vigilant and educated on how to keep your blood sugars under control.

First, it is important to know that while most Muslims practice strict adherence to fasting during Ramadan, fasting is not required. The Quran does not recommend fasting if it could harm ones’ health– particularly for those who are sick, pregnant, or elderly. Therefore, those with poorly controlled diabetes should not fast if it puts their health at risk. However, diabetes can be safely managed while fasting. You should continue to take your medications during Ramadan, but depending on blood sugar levels, timing or dosage may require modification.

As those with diabetes know, eating consistent carbohydrates and timing of medication are important to keeping blood sugars regulated. Fasting, however, can deregulate this system and cause dangerous effects including dehydration and hypoglycemia throughout the day. Furthermore, the large influx of food when breaking the fast at sundown can cause hyperglycemia in diabetics.

For these reasons, it is important to routinely check blood sugars (which does not count as breaking your fast) and monitor your physical symptoms to avoid dehydration and hypoglycemia. Hypoglycemia is technically defined as glucose levels below 70mg/dl, and can cause dizziness, lightheadedness, hunger, and disorientation. This state should be treated immediately with small amounts of food, juice, or a glucose tab to restore normal blood sugars. If this condition occurs, there are options to avoid re-occurrence, and you should contact your medical provider to alter medications or discuss other acceptable ways of breaking the fast if necessary.

Conversely, when breaking your fast you should be cautious about consuming too many carbohydrates at one time, which can cause hyperglycemia. As usual, try to keep carbohydrate amounts close to normal goals (when not fasting), and eat adequate amounts of protein and vegetables to help blunt possible spikes in blood sugar. Furthermore, it is important to start the day with a hearty meal of complex carbohydrates and protein to slow digestion and provide fullness and adequate fuel throughout the day.

Just as Ramadan is a time for self-reflection, if you are managing diabetes it is important to be in tune with your body and its physical symptoms. While it is certainly possible to manage diabetes while fasting during Ramadan, each person’s body will react differently.  It is important to contact your health care provider to discuss ways to coordinate diabetes management with your religious practices ahead of time in order to keep both your body and mind healthy and well.

(Post reviewed by Melanie Pearsall, RD, CDE, MGH Revere HealthCare Center)

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