With less than a month away to start the holy month of Ramadan, all patients with diabetes who wish to fast during Ramadan should undergo the required arrangements to undertake the fast as safely as possible. These include medical assessment and educational counselling.
This assessment should take place within one month before Ramadan. They must visit their Diabetes doctor. Specific consideration should be devoted to the overall well-being of the patient and to the control of their sugar levels, blood pressure, and level of hydration.
Appropriate blood studies should be ordered and evaluated. Specific medical advice must be provided to each individual patient concerning the potential risks they are accepting in deciding to fast, even if they fast against medical advice. During this assessment, necessary changes in their diet or medication regimen and doses should be made earlier so that the patient initiates fasting while being on a stable and effective program.
Based on age, type of diabetes (type 1 vs Type 2), type medications, existing kidney or heart complications, frequency and seriousness of low blood sugar attacks, pregnancy, presence of family support, availability of blood sugar measuring device and their 3 months sugar average A1c level before Ramadan, the doctor will then recommend against or allow fasting if safe. Low blood sugar mostly during fasting, High Blood sugar mostly in the evening, developing ketone bodies in those on Insulin or others severely distressed, dehydration, low blood pressure and increase risk of vein thrombosis are all feared outcome in prolonged fasting.
Majority of patients who fast are type 2 diabetes (adult onset diabetes on oral medications or Insulin) and around 50% of type 1 Diabetes (children with Insulin multiple injections or Insulin Pump). In pregnancy, fetal distress and mother distress should be discussed and many physicians advice against fasting unless pregnant patient is well controlled on diet alone.
It is vital that the patients and family receive the necessary education concerning self-care, including signs and symptoms of high and low blood sugar levels, blood glucose monitoring, meal planning, physical activity, timing of medication administration and dose adjustments, and management of acute complications.
Adequate nutrition and hydration should be emphasized, in addition to ensuring preparedness to treat low sugar reactions promptly should it occur, even if it is mild (use of glucose gel, glucose-containing liquids, glucose tablets, or glucagons injection by family members or friends; wearing of medical alert bracelet).
Wishing you all a safe and healthy Ramadan