Ramadan and diabetes
Bashir sahib wants to fast all of Ramadan, the way he always has. On day nine, at four in the afternoon, his meter has other ideas.
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Six weeks before Ramadan, Bashir sahib has already made up his mind.
“I'll fast every day, same as every year. I'll just take my tablets at iftar and sehri.”
“Ask Dr. Sahib first. Moving tablets around is his job, not yours.”
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“Good that you came early.”
See your doctor 6 to 8 weeks before Ramadan. The doses and timings of diabetes medicines usually need to change.
At this visit your doctor works out your risk, checks your HbA1c and kidney function, and adjusts your medicines — the dose and the time of day.
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People in the high-risk group are advised not to fast. That includes anyone who has had a severe hypo in the three months before Ramadan, has repeated hypos, or no longer feels the warning signs of a hypo.
Some changes are predictable. Glibenclamide, an older sulphonylurea, is best avoided in Ramadan in favour of newer ones such as gliclazide. Insulin is continued with its doses changed, not stopped. Don't make these changes yourself: the right dose depends on your own readings.
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He leaves with a written plan. On the first evening of Ramadan, the family gathers on the roof.
“And Dr. Sahib's rule: below 70 or above 300, you break the fast. No arguments.”
- Your sugar is below 70 mg/dL (3.9 mmol/L).
- Your sugar is above 300 mg/dL (16.7 mmol/L).
- You have symptoms of a hypo, of very high sugar or of dehydration — or you fall ill.
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Day nine. Four o'clock in the courtyard, and the shaking is back. The meter reads 64 mg/dL.
“Iftar is only two hours away. I can hold on.”
What should he do?
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AHold on until iftar.
What happens instead
Break the fast at once if your sugar is below 70 mg/dL or above 300 mg/dL, or if you feel unwell.
BBreak the fast and treat the low now.
✓ The right step
Break the fast and treat it straight away: 15 g of fast sugar — 3 teaspoons of sugar in water — then check again after 15 minutes. Tell your doctor, because the plan needs changing.
CSip plain water, so the fast is only half broken.
What happens instead
“Water won't lift a low. Sugar in water will.”
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Fifteen minutes later: 92 mg/dL.
Islam exempts people who are ill from fasting, and many people with diabetes fast anyway.
“I'll tell Dr. Sahib today. The plan needs changing.”
Check your sugar more often than usual: before sehri, during the day, before iftar, and whenever you feel unwell.
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That evening on the roof, he opens his fast the way the plan says.
Taraweeh counts as exercise. Heavy exercise during the fasting hours raises the risk of hypos and dehydration, so walk after iftar instead.
- Eat sehri as late as possible, not at midnight.
- Open the fast with water and a date or two, then eat a normal meal rather than a feast.
- Keep pakoras, samosas and sweet sharbat for once in a while; sugary drinks send glucose up fast.
- Drink plenty of water between iftar and sehri.
What to remember
- See your doctor 6 to 8 weeks before Ramadan. The doses and timings of diabetes medicines usually need to change.
- Break the fast at once if your sugar is below 70 mg/dL or above 300 mg/dL, or if you feel unwell.
- People at high risk — for example after a severe hypo in the three months before Ramadan — are advised not to fast.
- Eat sehri as late as possible, drink plenty of water between iftar and sehri, and keep fried food and sweet sharbat for once in a while.