Frequently Asked Questions For Diabetics About Fasting In Ramadan

1. As a person with diabetes, am I at risk of harm if I fast during Ramadan?

While fasting is considered safe for most individuals, the holy Quran states that fasting should be avoided if it is considered to be detrimental to an individual’s health. Having diabetes will put you at an increased risk for low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), blood clots and dehydration.

It is important to understand that you must immediately break your fast if you have one of the following:

1. A blood glucose less than 70 mg/dL (4 mmol/L)
2. A blood glucose more than 300 mg/dL (16.7 mmol/L)
3. Symptoms of hypoglycemia, hyperglycemia, or acute illness occur

The symptoms of hypoglycemia, or low blood sugar, vary from person to person and can change over time. These symptoms can include one or more of the following:

• Sweating
• Shaking
• Palpitations
• Hunger
• Nausea
• Anxiety
• Tingling
• Fatigue
• Weakness
• Headache
• Dizziness
• Confusion
• Difficulty concentrating
• Difficulty speaking
• Loss of consciousness

The symptoms of hyperglycemia, or high blood sugar, vary from person to person and can change over time. These symptoms can include one or more of the following:

• Dry mouth
• Extreme thirst
• Frequent urination
• Weakness
• Fruity breath
• Stomach pain, nausea and vomiting
• Deep, rapid breathing

2. If I decide to fast, what should I do?

• Delay Suhur as much as possible in order to provide energy for the long hours of fasting
• Have a healthy balanced Iftar during Ramadan. Limit food and beverages that are high in sugars and/or fats and consume foods rich in fiber.
• Drink plenty of water. Avoid high sugar drinks, such as sodas or artificial juices as they tend to dehydrate rather than hydrate.

3. How often should I check my blood glucose levels while fasting?

• If you are fasting for the first time after being diagnosed with diabetes or considered high risk to develop low blood sugar, it would be good to closely monitor your blood glucose levels for the first week (morning, midday, before Iftar, two hours after Iftar, before Suhur or when feeling unwell)
• If you are accustomed to fasting while being diabetic you may check your blood glucose 3 times per day: mid of day, before iftar, before sohour or when feeling unwell.

Note: Checking for blood glucose level during fasting hours does NOT break the fast.

4. Can I exercise while fasting?

Yes, you may exercise during Ramadan but the recommendation is to perform light to moderate exercise after Iftar. It’s important to note that prolonged and extended Tarawih prayers are considered a part of the daily exercise plan and might cause low blood sugar.

5. If I decide to fast, how do I manage or adjust my current medications?

Adjusting the dose and timing of your medications will depend on the type of medication, the timing, the duration of fasting and the indication for the medication. It is best to consult with your Pharmacist or Physician to assist with adjusting your medications.

6. If I decide to fast, when should I take my insulin?

• If you will break your fast with a snack only (example: soup, yoghurt, dates, or sambusa) postpone administration of your rapid insulin such as lispro (HumaLOG) or aspart (NovoRAPID) in order to avoid a low blood sugar
• Administer the rapid-acting insulin immediately before your main iftar meal (i.e. harees, machboos, biryani).

7. Do all types of medications nullify the fast?

You may administer several medications without your fasting being affected:

• Ear and eye drops, nose drops, nose sprays, and inhalers.
• All substances absorbed into the body through the skin such as creams & ointments.
• Anal or vaginal inserts.
• Injections through the skin, muscle, joints, or veins except for intravenous feeding.
• Rinsing, gargling or topical treatment in the mouth.

8. What do I do if I have further questions?

• Always Consult Your Pharmacist if you have questions about your medications or therapy.
• You can also visit the Cleveland Clinic Abu Dhabi for a Pre-Ramadan Assessment at least 6-8 weeks before Ramadan. To book an appointment, call 800 8 2223.
• If you have questions about which medications nullify your fasting, you may contact the General Authority for Islamic Affairs and Endowments “Dar Al Iftaa” at 800 2422.

LOW BLOOD SUGAR (HYPOGLYCEMIA)

What is low blood sugar?

Low blood sugar or hypoglycemia is when your blood sugar falls to less than 70 mg/dL (4 mmol/L). This can happen to people with diabetes who take insulin or other diabetes medication. Some people with diabetes develop symptoms of low blood sugar at slightly higher levels. If your blood sugar levels are high for long periods of time, you may have symptoms and feel poorly when they drop closer to 100 mg/dL (5.6 mmol/L).

What symptoms might I have if my blood sugar is low?

If your blood sugar is low, you may experience one or more of the following symptoms:

• Sweating
• Shaking
• Palpitations
• Hunger
• Nausea
• Anxiety
• Tingling
• Fatigue
• Weakness
• Headache
• Dizziness
• Confusion
• Difficulty concentrating
• Difficulty speaking
• Loss of consciousness

What causes low blood sugar?

There are many factors that cause low blood sugar including:

• Taking too much diabetes medication or insulin
• Missed or delayed meals
• Eating a smaller meal than normal
• Increased or unexpected exercise

How can I prevent low blood sugar?

• The best way to prevent low blood sugar is to monitor your blood sugar levels frequently and be prepared to treat it promptly at all times. You and a close friend or relative need to learn the symptoms and should always carry glucose tablets or other sources of fast-acting carbohydrate.

What do I do if I think my blood sugar is low?

Step 1:

Test your blood sugar (If unable to test, treat as if blood sugar is less than 70 mg/dL or 4 mmol/L)

Step 2:

If your blood sugar is low (less than 70 mg/dL or 4 mmol/L), treat immediately as follows:

Eat or drink 15-20 g of a fast-acting carbohydrate. Choose one of the following:

Step 3:

Wait 15 minutes then retest your blood sugar. If your blood sugar is still less than 70 mg/dL or 4 mmol/L, repeat step 2 until your blood sugar is more than 70 mg/dL (4 mmol/L)

Step 4:

If your next meal is more than an hour away, eat a small snack: