Category: General

Saliva plays a vital role in protecting your mouth and reducing bacterial growth. The reduction of salivary flow while fasting is the main reason for bad breath. Reduced saliva production will cause bacteria to multiply in the mouth more quickly. As a result, bacteria can produce gases that give off an unpleasant odour, causing bad breath. Once the person starts eating, the salivary glands are soon stimulated, and saliva production becomes normal. People with diabetes have higher glucose content in saliva, favouring the growth of bacteria and periodontal infections. This places them at a higher risk of bad breath. In addition, since saliva production suffers during fasting, bad breath may likely be troublesome in people with diabetes.

Yes. For a person with diabetes, mild to moderate physical activity levels can be a part of their day-to-day life, even during fasting. Following precautions in the duration, timing, and intensity of exercise can help avoid common complications seen during fasting. Individuals can exercise at a low intensity but for a maximum of 35 minutes, focusing predominantly on aerobic and strength training. This is generally safe in people with diabetes and can help control blood glucose. People who are used to more intensive exercise can pursue the same with more glucose monitoring to avoid hypoglycemia. Health professionals can discuss moderate resistance training / low-intensity cardio workouts instead of intensive exercise regimes. Brisk walking, stair climbing, yoga, swimming, Tai- Chi, and cycling are low-intensity exercises that people with diabetes can perform during fasting. Individuals can perform these exercises five times per week or 150 minutes per week to optimize their health and control their blood glucose levels.

Ramadan is an ideal opportunity to fine-tune the strength and desire required to adhere to good dietary habits. Nutrition advice offered to an individual by an expert dietician helps to alter and achieve structured dietary change during Ramadan. If a person is already practising a diet for weight loss before Ramadan fasting, they can continue it after getting professional advice. Consideration should be given to prevent dehydration. Healthy weight loss results in better control of glucose. Gradual weight loss of 0.5-1kg per week is desirable. If you are into an exercise plan, you may be unable to follow the same during Ramadan fasting. Therefore, you should plan the time and the type of exercise. Even for diet modifications, you should plan to modify the diet during the non-fasting hours.

Most people with hypothyroidism consume their thyroxin tablets (Eltroxin, Thyronorm, Euthyrox etc.) on an empty stomach after waking up. This is followed by the next meal or drink after 30-60 minutes. However, during Ramadan fasting, people find it challenging to consume the medicine and then fast for the next 30-60 minutes. Therefore, they can consider taking the tablets 30 minutes before Suhoor meal or 1 hour after the night snack before to bed. Scientific studies have shown that bedtime intake of thyroxine results in good absorption of the tablets. It is less of a challenge for people with hyperthyroidism to consume Carbimazole or Methimazole. However, doctors should avoid radioactive iodine therapy in people with hyperthyroidism around the time of Ramadan fast. This is to prevent the potential risk of worsening hyperthyroidism that can happen following the ablation and avoid the risk of hypothyroidism and subsequent doctor visits during Ramadan fast.

It is better to avoid fasting following a severe infection within the last three months before fasting. Some people who had COVID 19 in the past may experience a prolonged and severe post-COVID syndrome. Some have a heightened risk of developing blood clots, blood pressure and heart rate variations, extreme exhaustion, and even lung fibrosis. People with prolonged illness secondary to COVID-19 can become severely dehydrated and risk sudden acute deterioration during fasting. Hence it is safe to abstain from fasting and let your body slowly recover. It is wise to undergo an assessment with your treating doctor to see if you can observe the fast. Please follow his advice closely on whether to fast or not.

According to scientific studies, there is a 3-fold increase in the risk of migraine during Ramadan fasting. Migraine can be triggered by stress, hunger, low glucose levels, dehydration, irregular sleeping habits, and acidity. When you observe fasting for more than 12 hours, these problems can arise, leading to another episode of migraine headache. However, if you plan to observe fasting, you must continue to take the prescribed medicine. Caffeine withdrawal can lead to increased migraines. If you regularly take caffeine, it is good to have a strong coffee at Suhoor. Increase the quantity of water during non-fasting hours to avoid dehydration. Make sure that you get enough sleep and reduce the use of smartphones. If the episodes of migraine worsen, consider abandoning the fast.

Yes. It is normal to find ketones in urine while fasting. During any typical day, the food that we intake contains carbohydrates that get digested into glucose, and this gets absorbed. This glucose provides the energy for our everyday activities. The additional glucose is stored in the liver and muscles. But during a fasting day, since there is no food intake, the glucose stored in the liver and muscles is used to maintain blood glucose levels. But with prolonged fasting, this alone is insufficient, and fat breakdown occurs to supply energy. Ketones are produced as a by-product during fat breakdown. In general, if your glucose levels are normal and you feel fine, these ketone levels are not dangerous. However, if your blood glucose is more than 200 mg/dl or you feel tired, have vomiting, or feel giddy, you should consult your doctor. If you have a fever, dehydration, or any infections, your doctor may give more importance to the ketones in the urine and ask you to abandon fasting.

It is now accepted that self-monitoring blood glucose with a glucometer does not invalidate the fast. People with diabetes should be educated about the frequency of monitoring during the pre-Ramadan education. The number of times blood glucose should be monitored differs according to the different risk categories of the patient. Regular glucose monitoring may not be required for people with well-controlled blood glucose levels and on medicines that do not cause low glucose (Metformin, SGLT2 inhibitors, DPP4 inhibitors). If you have well-controlled diabetes on oral drugs that cause hypoglycemia or insulin, you need to check at least two times daily. If glucose levels are not well controlled and you have diabetes complications, you need to check glucose more frequently.

An ideal 7-point glucose profile recommendation by IDF is as follows:

1. Pre-dawn meal (Suhoor)
2. Morning
3. Midday
4. Mid-afternoon
5. Pre-sunset meal (Iftar)
6. Two hours after Iftar
7. At any time when there are symptoms of hypoglycemia/ hyperglycemia or feelings of being unwell

Everyone with diabetes planning to observe fasting should undergo a pre-Ramadan check-up. This check-up assesses each person’s glucose control, diabetic complications, and safety in observing fast. The treating doctor will investigate the glucose control, risk and severity of diabetes complications, risk of possible hypoglycemia during fasting, and the potential for worsening complications. The check-ups include tests of glucose control, kidney functions, liver function, assessment of eye issues, and cardiovascular disease. Based on these reports and clinical evaluation, the doctor will help classify your risk for fasting. People with low risk can observe fasting without much risk of worsening the disease. Those with high risk should preferably avoid fasting.

People with type 2 diabetes at low risk of developing complications according to their current disease state are allowed to fast. This includes individuals with a shorter duration of type 2 diabetes (< 10 years), reasonably well-controlled glucose levels (HbA1c < 7.5 %), no major chronic diabetes complications, or no recent hospitalization for high or low glucose. However, if individuals choose to fast, they should be cautious and discontinue fasting if any problems arise. Likewise, those with uncontrolled type 2 diabetes, type 1 diabetes, and people with diabetes-related complications belonging to the high-risk category should refrain from fasting. People with diabetes planning to fast should meet their treating doctors and discuss the risks and safety of fasting. Your doctor is the best person to decide if it is safe for you to fast.