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Diabetes and Ramadan

I have a few friends who celebrate Ramadan and have always wondered what I would do being type 1 and trying to celebrate Ramadan.

Ramadan is a period for worship, self-discipline, austerity and charity. Fasting is obligatory for all healthy adult Muslims, with no food or drink being consumed between dawn and sunset. There are only 2 meals a day pre-dawn and after sunset.

As the Islamic calendar year begins with the sighting of the new moon, Ramadan starts 10 days earlier each year. This year Ramadan starts on Wednesday 10th August and ends 30 days later Thursday 9th September.

I found the following information useful and came to the conclusion that if I did celebrate Ramadan I would be able to as long as my levels were already uner control!

There are certain exemptions from fasting:

  • Children under the age of puberty
  • Those with learning difficulties
  • The old and frail
  • The acutely unwell
  • Those with chronic illnesses for whom fasting may be detrimental to health
  • Patients with diabetes fall into this last category, but may prefer to meet their religious obligations by fasting.

    There are certain medical conditions that should prohibit a person from fasting, they are:

  • People with “brittle” type 1 diabetes – unstable sugars
  • Type 1 or type 2 patients with poor blood suagr control
  • Individuals who can not observe their diet or mediaction
  • Patients with a history of diabetic contracts
  • Pregnant women
  • Patients with intercurrent infections
  • Patients with renal impairment of any severity (risk of dehydration and uraemia)
  • Elderly patients with reduced alertness
  • Those who have previously experienced severe deterioration in glycaemic control during Ramadan
  • For diabetic patients who choose to observe Ramadan there are a number of risks as a direct consequence of fasting. These include the risk of low blood sugar levels (known as hypoglycaemia) in patients treated with insulin or sulphonylureas (tablets) and risk of a coma (Ketoacidosis) in type 1 diabetic patients. When Ramadan falls within the summer months, there is an even greater potential of hazards due to prolonged hours of fasting in the day. Factors that could contribute to these risks are an alteration of eating pattern; lack of correct timing and dose of insulin, and a lack of adjustment to the dose and timing of oral medication.

    Hazards Of Fasting

    For diabetic patients who choose to observe Ramadan there are a number of risks as a direct consequence of fasting. These include the risk of low blood sugar levels (known as hypoglycaemia) in patients treated with insulin or sulphonylureas (tablets) and risk of a coma (Ketoacidosis) in type 1 diabetic patients. When Ramadan falls within the summer months, there is an even greater potential of hazards due to prolonged hours of fasting in the day.

    Factors that could contribute to these risks are an alteration of eating pattern; lack of correct timing and dose of insulin, and a lack of adjustment to the dose and timing of oral medication.

    Patients On Insulin

    There should be no need for a drastic reduction in the total dose of insulin. Many patients are insulin resistant and will still require large doses.

    Many patients normally use premixed insulin (Mixtard, Humulin, Humalog Mix). It is advisable to reverse the morning and evening dose, if the doses are the same, the morning dose should be reduced by about 50% and a corresponding larger dose taken before the sunset meal.

    Patients who are on a basal bolus regime should reverse their bedtime intermediate acting insulin (Insulatard, Humulin I) to the pre-dawn meal and then take their short acting insulin (Actrapid, Humulin S, Novorapid, Humalog) before each meal taken. Further adjustment to insulin dosages are likely to be needed after these initial suggestions have been instituted.

    Patients On Oral Medication

    Patients taking Metformin alone are at no risk of hypoglycaemia and fasting poses little hazard. If a dose is usually taken at lunchtime it can be taken with the sunset meal.

    Patients on a once-daily agent such as Glimepiride with breakfast, should be advised to take it with the sunset meal.

    Patients taking a sulphonylurea should use a short acting agent i.e. Gliclazide and the morning and evening doses reversed during the fast. Long acting agents such as Glibenclamide are hazardous and should be avoided.