Diabetes Mellitus And Fasting (Puasa) During Ramadhan - Guidelines for Diabetes Management

For the majority fasting is possible, and for the overweight non-insulin dependent diabetics fasting in fact may be desirable and help weight loss.

Patients must follow closely their prescribed diet as to the total calories for the day and proportion of carbohydrate, fat and protein. Gorging of food especially those containing simple 'refined' carbohydrates after "opening fasting" must be avoided. The total daily calorie allowance should be spread over the non-fasting period, i.e. during the night. This means taking small to moderate amount after Maghrib prayers, after Terawih and at sahur. Sahur should be taken as near Imsak as possible and not at midnight or after. Snack meals as usually practiced by insulin-treated diabetes  will now not be possible during the day.

Often we observe weight gain in a sizeable number of diabetic as the total amount of food eaten is unchanged but physical activity if often reduced. Excessive exercise is usually curtailed during Ramadhan. This is necessary as over-exertion and exposure to the hot sun may cause dehydration and hypoglycaemia.

Patients should continue with self-monitoring of blood glucose as this will safeguard against serious disturbance of blood glucose level during the day especially in the first week of Ramadan. It is beast to check the level at around 9am,  3 to 4 pm and about 2 hours after "open fast". This will allow necessary changes to be made.

Medications

Generally, the usually medication taken during non-fasting months have to be reversed, i.e. those given for pre-breakfast should now be taken at "open fast" and those before dinner be taken before sahur. Should hypoglycaemia occur in the afternoon, the sahur dose should be reduced or a bigger portion of the medication be taken at "open fast".

Oral Hypoglycaemics (Tablets)

The 2 groups of drugs, namely, metformin and sulphonylureas must be considered separately.

Those on metformin (glucophage) should be able to fast without risk of hypoglycaemia. However, with regards to sulphonylureas, short-acting drugs like glipizide (minidiab) are preferred to longer-acting ones. In high risk groups, for example, elderly patients or those with kidney failure, a reduction in the dose be required. Your doctor must be consulted.

Insulin

Insulin treated patients should carefully weigh the sagely of fasting and should discuss with their doctors and Ustazs (religious teachers). The need for monitoring is even stronger in this group.

Those on single daily dose of intermediate-acting insulin (such as Monotard or Humulin N) should give injection at the time of "open fasting".

On the other hand, twice daily short-acting insulin (eg. Actrapid or Humulin R) before "open fasting".

The majority of those with twice a day mixture of short and intermediate-acting insulins, may need to continue on these but the dose may have to be reduced or modified according to meal patterns and blood glucose levels. The dose of longer-acting insulins given at sahur may also need to be reduced.

Fasting is OK for Diabetcis!

It is therefore possible for Muslim diabetics to carry out their religious obligations without fear and anguish. It must be stressed that they should discuss it with their doctors before Ramadan and practise it during the Puasa Sunat of Rejab or Saaban. The necessary adjustment and advice can be made to ensure safety and comfort throughout the Holy month of Ramadan.