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)

Test Prep

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen W

It’s always a little nerve-wracking when you have to undergo medical tests.  Instructions  can range from very simple, to vague, to extremely detailed.  Eat, don’t eat; take some medications but not others. It makes you feel like you’re on your way to an 8th grade spelling test, convinced of a low score before even getting out of bed.  Everybody feels like that, trust me, but sometimes there are certain extra steps ot test prep if you have Diabetes.  I want to review some of the more common examples, but please note this list isn’t exhaustive.  ALWAYS check with your health care provider for specialized directions.

The timing of tests, regardless of what it is, is crucial to your Diabetes self-care.  I always suggest to patients that they get the earliest appointment of the day whenever possible. You may have to check your blood sugar more frequently if you need to fast before the test, and may need to adjust both your long and rapid acting insulin as well as oral agents such as Glyburide, Glipizide, or Glimepiride (Sulfonylureas).  In fact, you may need to hold these medications all together.

Tests requiring the use of dye also may also mean medication schedule changes.  Patients taking Metformin or Glucophage are often asked to hold these medications for up to 48 hours before and after the test (dye used in tests is cleared by the kidneys, so use of Metformin/Glucophage may cause some changes in kidney function).  Again, careful blood sugar monitoring and dietary care will be extra important during this time.

The test that causes the greatest amount of confusion for my patients, however, is the colonoscopy.  The prep for this test can start several days prior and greatly impacts diet and medication schedules.  Also, insulin doses will need to be adjusted.  Therefore, it is imperative that you review your medication dosing schedule with your care team at least one month before your test. 

I also want to stress that it may take a couple of days to get your blood sugars back on track after the test.  Any disruption in your schedule may alter your blood sugar, so careful self-monitoring is key.  Taking a little bit of time to plan ahead can make these tests a little less stressful.  And, of course, I wish you luck with all of this!