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Fasting and Ramadan

As Ramadan is at hand, Muslims all over the country and indeed globally are preparing to observe this holy month of fasting.

Islam requires Muslims to fast during the month of Ramadan from sunrise to sunset, a period of up to 16 hours of each day. An exception to this fast includes people who are ill or that have medical conditions that make them unable to fast. This includes people with diabetes.

Long fasts in patients with diabetes puts extra stress on their body and increases the risk of dehydration, low or high blood glucose. Fasting with diabetes requires careful diabetes management. Many patients with diabetes still choose to fast despite this risk. As healthcare providers delivering patient-centered care, we do the best to accommodate this choice. While the decision to fast is a personal one, Muslim people with diabetes who choose to fast should consult with their doctors and healthcare providers before fasting.

This is to discuss potential risks and practical steps to mitigate these risks during the fasting period. In some high risk patients with diabetes, prolonged fasting may not be advisable. Sometimes however you may need to schedule a visit to your Consultant Physician (Endocrinologist, Diabetologist, Cardiologist) who may make further adjustments to the way you take your medications and the doses of your medications.

If you chose to fast after due consultation with your healthcare provider, these steps will help in reducing the risks associated with fasting.

Steps to Reducing Risks Associated with Fasting

1. Do an HbA1c test before the start of fasting to ensure your glucose control is adequate before the fasting period. [This test takes about 45-60 minutes after a small blood sample is taken at most laboratories including the CardioCare Cardiovascular Specialty Hospital ‘s laboratory]

2. Check your blood glucose more often than usual during the fasting period.

3. Your medications may be changed to those that have less risk of low blood sugar during fasting.

4. Include more slowly-digested food such as beans in your pre-fast and post fast meals, with fruits and vegetables.

5. Avoid overeating after breaking your fast in the evening and avoid sweetened food items.6. Take plenty water before and after fasting to keep yourself well hydrated.

7. If you are taking insulin, the type of insulin and the regimen may need to be changed during the fast.

8. The amount of insulin you require may also be reduced.

9. In people with diabetes complicated by heart, kidney disease or poor vision – the risk associated with fasting is much higher and they should seriously consider not fasting.

10. The risk of high blood glucose is higher in people who inappropriately reduced or stopped their medications because of fasting. It is also higher in people who eat excessive calories when breaking their fast and in people who become more sedentary than usual during the fasting period.

11. The risk of low blood glucose is higher in people taking certain medications or insulin. This risk can be reduced by proper medication review before commencement of the fasting period.

12. If you are feeling unusual (like you are having low blood glucose) during the fast, you should break the fast, test your glucose and consume sugary/starchy drink to treat yourself. Most hospitals can avail of this service, or you may wish to visit the CardioCare Cardiovascular Specialty Hospital which specializes in treatment and public health education of cardiovascular diseases like diabetes, hypertension and other conditions. You would see a specialist in the field who would recommend necessary tests and medication changes for the fasting period

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