Diabetes Mellitus And Fasting (Puasa) During Ramadhan - Potential Hazards

During the month of Ramadan, every healthy Muslim is expected to fast between sunrise and sunset- one of the 5 pillars of Islam. Islam does allow breaking of the fast in certain situations such as serious illness, advanced pregnancy, breast feeding, menstruation and for those traveling long distances. Those with chronic illness like diabetes mellitus may want to fast, and in the majority of cases this is feasible.

In the Tropics, fasting is observed over a period of 14 to 16 hours between dawn and dusk, during which the individual will be deprived of foods and drinks including oral medications. On the other hand, individuals may indulge excessively in sweetened drinks and delicacies immediately after the call for Maghrib prayers, signifying the end of the fast for the day (plus a 24 hours worth of cigarettes!). Often supper is eaten on returning from Terawih prayers and food is again taken for sahur between 4 to 5 am. There is thus an alteration in the eating pattern to which non-diabetics can adjust rather quickly. However, this can put some strain on the metabolic status of a diabetic. In addition, it is observed that even diabetics cannot resist the temptation of taking sweetened delicacies during this month.

Potential Hazards

Diabetics are not discouraged from fasting, but they must understand the potential dangers under certain circumstances. We, therefore, advise all diabetes to discuss this with their doctors before Ramadan as fasting can be hazardous for some.

Poorly controlled diabetics may lose excessive water because of the high blood glucose. When the kidneys cannot conserve water the patient will suffer from dehydration and more so if the patient continues to fast. The same may occur if there is kidney disease either as a result of diabetes or as a complication of high blood pressure.

Those with "brittle diabetes: with a tendency to a sudden severe hypoglycaemia (low blood glucose) and those prone to develop ketoacidosis should not fast. Patients with advanced heart disease, stroke and fever due to infections would fall into the same category where fasting is not advisable.

Fasting may be dangerous for those who do not sense the fall in blood glucose and may become unconscious without warming. This is likely to happen in patients with nerve damage -- autonomic neuropathy.