In the final part of this series, we continue our look at how Muslim Diabetics remain well during Ramadan.

By Dr S Kama-Kieghe

Introduction

In part one, we learn that it is important for Muslim Diabetics to be aware that possibly serious complications and ill health can occur if their condition is not stable; or if a lengthy fast is inappropriate for them.

We showed why it is important for health care providers to conduct pre-assessments and identify risks for ill health.

Next, we look at how best to manage Diabetes during and after the fasting period.

Section I – During The Fast

Maintaining Stable Blood Sugar Levels While Fasting

The key actions to take to keep control of blood sugar (blood glucose) levels are:

• First, health providers must respect the choice of a Muslim Diabetic to fast, but provide as much information for them to make safe and smart health decisions.

In addition to risk assessment, it is important to develop a plan that is specific to the individual depending on their other medical history and medications.

There may be a need to adjust current medications by changing their dose to reduce the risk of hypoglycaemia.

• Blood sugar monitoring is important – even during the daytime fast. Checking blood sugar levels frequently – and more often than usual will help.
• This is important because blood sugar levels will vary during the day.

Hypoglycaemia (when the blood sugar drops very low: less than 4mmol/l or 72mg/dl) can happen during periods of stress/ illness/ missed meals/or if taking insulin or one of the Sulphonylurea oral drugs eg Gliclazide, Glimepiride or Glipizide.

Meal Suggestions

• We should advise people to eat simple carbs at the evening meal and complex carbs during the morning meal.

Low-glycemic-index, high-fibre carbohydrates are preferable – such as:

• Fruits – bananas, oranges, apples, mangoes, strawberries, raspberries.
• Vegetables – generally, the darker the colour, the higher the fibre content.
• Beans & Legumes are flavorful and fibre-filled.
• Wholewheat bread & grains.
• Nuts.

Low-calorie snacks such as nuts, fruits, or vegetables can be consumed between meals at night.

Important references should be made towards food preparation and portions, too.

It is advisable to limit fried foods and deep-frying – instead of baking, shallow frying, grilling being preferable methods to reduce the fat consumed.

Another tip is to encourage diabetics to space out meals – with small portion sizes.

Fruits, vegetables and yoghurt can be taken in meals at Iftar and Suhoor/Sehri and snacks between.

Monitoring Blood Sugar Levels

When fasting, we would recommend that Diabetic patients should break the fast:

• if their blood sugar goes below 70 mg/dL (3.9 mmol/L) or above 300 mg/dL (16.6 mmol/L);
• in case they develop nausea, vomiting, or orthostatic dizziness (that means, dizziness if they change position – sitting up from lying down or standing up from sitting);
• if they notice elevated ketone levels on testing or suddenly fall ill.
• We also encourage family members to be aware of Diabetes complications and the information above.

Section II – After The Fast

Eating Safely Must Continue After the Fast?

After successfully completing the fast and avoiding ill health, diabetics can gradually resume full meals with care.

Some celebratory events follow Ramadan; including the Eid el Fitr, where lots of high-carb or sugary foods are consumed.

Many Muslims may indulge in communal feasting, with family and friends eating a mixture of different foods from shared platters.

This may prevent people from judging portion sizes properly leading to sharp changes in sugar levels.

In addition to portion control, diabetics should also ensure hydration, restart their pre-Ramadan diabetes medication regimen, and monitor blood sugars closely during the Eid celebrations.

Finally, it’s important to say that with planning, collaboration and simple adherence to a plan of agreed medication regime and meal practices, many Muslim diabetics will safely complete the fast and benefit from their experience.

Read More:

• Can Muslim Diabetics Remain Well at Ramadan? – Part 1
• Risk Assessments for Muslim Diabetics at Ramadan
• Women’s Health Section
• Top 10 tips for healthy eating in older children
• Living with Diabetes – 9 recommended lifestyle changes

Edited by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
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