Fasting with Diabetes: Observe a Healthy and Safe Ramadan

Every year, during the Holy Month of Ramadan, an estimated 50 million people with diabetes practice daily fasting. Here’s some vital facts and tips to ensure that you observe the Holy Month in full measure, without affecting your health.

What happens to your body when you fast?

Fasting begins to affect the body typically eight hours after your last meal. Your body starts to use stored up energy through glucose and fat. If you’re on insulin medication for diabetes, then even more glucose is utilized than normal, putting you at risk of hypoglycemia (low blood sugar level).

On the other hand, you may also experience hyperglycemia (high blood sugar level) when your body resorts to producing glucose from the liver itself.

Is it okay to fast if you have diabetes?

If you are diabetic and planning to fast during Ramadan, it is important that you visit your doctor to plan your month beforehand. Your doctor will revise your insulin dosage and times based on your fasting schedule.

Managing your medications while fasting

As your meal times change, so should your insulin dosage. Often, doctors advise to take the dosage before breaking your fast, especially when you eat your main meal at Iftar. If you are going to break your fast with dates and laban or water, and go to pray before eating your main meal, you may need to postpone taking your insulin dosage until then.

Precautions you need to take

• Never leave home without medication, glucose treatment and some sort of diabetes identification like a medical bracelet.
• Carry some dates, sugar, juice or anything that can raise your glucose level in case you experience hypoglycemia and need to break your fast.
• Keep testing your blood glucose regularly - it will not break your fast.
• Always carry a bottle of water with you, in case you feel dehydrated. It is safer to end your fast than to collapse or faint due to dehydration, one of the symptoms of hyperglycemia.
• Do not stop your insulin but do alter your dose and times as advised by your doctor.

When to eat?

While Suhoor and Iftar are the primary meals during Ramadan, it is best to have at least three meals in day, rather than two heavy meals. Cleveland Clinic Abu Dhabi nutritionist Azza Aljnebi, advises, “Try to have your Suhoor meal as late as possible and not earlier. This will help prevent hypoglycemia and give you energy to sustain you throughout your day.”

What to eat?

During Ramadan or otherwise, knowing what food gives you carbohydrates and converts to sugar is it the most important tool in managing diabetes. This helps you balance your diet and plan your meals wisely using the following five food groups:

• Grains: Choose whole grains over refined grains as they contain fiber that helps regulate sugar levels at a slow pace.
• Fruits: It is recommended to have 2-3 servings of whole fruit (rather than juice) spread throughout the day, 2-3 dates can be considered as one serving.
• Vegetables: Most vegetables do not convert to sugar except starchy ones like potatoes, beetroot, peas and corn. Eat these in moderation and as alternative to other starchy food.
• Dairy: All dairy except cheese can break down into sugar in your body. Take only 2-3 servings and in moderation.
• Protein: Protein doesn’t become sugar but starchy sources of protein like legumes, lentil and beans do. Therefore, if you wish to have hummus with bread, you will need to reduce your portions to half of each.

It's also important to keep hydrated, aim for at least 2-3 liters of water throughout non-fasting hours.

Try to reduce the following:

• Fatty and salty foods
• Juices
• Coffee, tea and fizzy drinks as they are diuretic and can cause dehydration

Aim to curbthe amount of sweets you eat, and to only have small portions 2-3 hours after Iftar, and preferably not every day.

Is it okay to exercise?

Exercise is another good way to keep your glucose levels in check. During Ramadan, it is best to do light or moderate exercise for at least 30 minutes between Iftar and Suhoor times only. Ensure that you are always hydrated too. What’s more, even performing your Taraweeh prayers can be included as part of your exercise regime.