Category: General

Low sugar or hypoglycemia can occur if there is a mismatch between the calories that you consume and utilization of the same. In subjects with diabetes, fasting for 12 hours without any consumption of calories makes you prone to developing low sugars. This is more common if the subject is on medicines like sulphonylurea(Glimiperide, Glibenclamide, Gliclazide, Glipizide) or on insulin.

If you are on any such medicines, you need to meet the doctor and adjust the doses so that there is no increased risk of hypoglycemia. Despite adjustments of medication doses, we suggest regular monitoring of blood sugars during the Ramadan fast.

Sometimes patients stop medications for diabetes due to fear of hypoglycemia or unscientifically reduce the dose. This can lead to high blood sugars during the day which can lead to excessive tiredness, hunger, thirst, excessive urination, electrolyte imbalance and weight loss. These patients can sometimes slip into serious consequences like diabetes ketoacidosis and hyperosmolar coma.

You should always seek medical advice during medication dose adjustment and monitor blood sugars during the fast.

Self monitoring of blood sugars helps you to know about the status of the blood sugar. You may be prone for high blood sugars and low blood sugars during the fast depending on your medications. We suggest you check the blood sugars at least 2-3 times daily during the fast. Blood sugar levels should be tested frequently, especially during the first hour of fasting, before Al – Zuhr (midday) and Al Asr (afternoon) prayers and before Iftar at Maghrib (sunset), so as to ensure that they stay under control.

Test readings should be discussed with the healthcare team who will adjust the frequency and timing of medication doses accordingly. It is suggested that you discontinue the fast if blood sugars are more than 300 mg/dl or less than 70 mg/dl. The best way to self monitor is by using a glucometer and not urine sugars. Be in touch with your diabetes care nurse or physician if you notice high or low blood sugars. Just monitoring blood sugars does not break a fast.

Subjects with diabetes can continue to exercise during Ramadan. 30 minutes is the preferred duration of exercise. The best time to exercise during Ramadan is the time before breaking fast in the evening. The exercise should be of moderate intensity and not too rigorous. The diet should have enough protein and subject should ensure enough hydration.

(http://www.health24.com/Fitness/Exercise/Exercising-during-Ramadan)

Before and after fasting include high fibre foods such as wholegrain cereals, granary, bread, brown rice, beans and pulses, fruit, vegetables, and salads. These should be slowly absorbable carbohydrates with a low glycemic index.

It is good to break the fast with a glass of milk and dates. A sensible portion is 2 dates. Dates are a source of energy and fibre. This should be followed by a balanced meal which includes wheat/rice, vegetables, fish (or lean meat), fruits and nuts. Remember to take the prescribed medications also along with the meal. Drink plenty of water to avoid dehydration which is a complication of Ramadan fasting. Dehydration can lead to headaches.

High sugar / high fat foods e.g. Indian sweets such as Ghulab Jamun, Rasgullay, Balushahi, Baklawa etc are preferably avoided during the Iftar. Milk-based sweets and puddings such as Rasmalai, Barfee etc are preferred. High fat cooked foods such as parhattas, oily curries, greasy pastries are better avoided.

These can be replaced with chapattis made without oil, baked or grilled meat and chicken. It may also be worth avoiding the caffeine content in drinks such as tea, coffee and cola(Caffeine is a diuretic and stimulates faster water loss through urination).

(Information courtesy: NHS Ramadan Health Guide)