DIABETES IN RAMADAN SHOULD I FAST OR NOT?
According to statistics in 2019 UAE population was around 10 million.
Out of which 19.3% are diabetic according to the international diabetic federation.
Fasting during the month of Ramadan for patients with diabetes carries a risk of multiple complications.
I general patients with Type 1 diabetics should be strongly advised to not fast.
That is to prevent hypoglycemia (below normal blood sugar) or hypoglycemia unawareness and especially those with poor glycemic control.
On the other hand, excessive reduction of insulin doses in these patients can lead to hyperglycemia (above normal blood sugar) and diabetic ketoacidosis.
Both conditions require emergency interference.
In Type 2 diabetics both hypo and hyper glycaemia can occur but generally less frequently and less severe compared to patients with type 1.
A patient’s decision to fast should be made after thorough discussion with his or her physician concerning the risks involved.
Patients who insist on fasting should undergo Pre-Ramadan assessment and receive appropriate education and instructions related to their physical activity, meal planning ,glucose monitoring ,and dosage and timing of medication .
The management plan should be highly individualized. Close follow up is essential to reduce the risk of complications.
Major risks associated with fasting patients with diabetes are:
1. Hypoglycemia
2. Hyperglycemia
3. Diabetic ketoacidosis
4. Dehydration and thrombosis
Categories of risks in patients with type 1 or type 2 diabetes who fast during Ramadan:
Very high risk:
1. severe hypoglycemia within the last 3 months.
2. patients with history of recurrent hypoglycemia.
3. patients with hypoglycemia unawareness.
4. patients with sustained poor glycemic control.
5. ketoacidosis within the last 3 months.
6. Type 1 diabetics.
7. Acute illness.
8. patients who perform intense physical labor.
10. pregnancy.
11. patients on renal dialysis.
High risk:
Patients with moderate hyperglycemia (average blood sugar between 150 and 300 mg/dl, HbA1C 7.5-9.0).
1. patients with renal insufficiency.
2. patients with advanced macro vascular complications.
3. patients living alone.
4. patients with co-morbid conditions that increase the risks.
5. old age with illness.
6. patients that are on drugs that affect mental activity.
Moderate risk:
Well controlled patients with short acting insulin.
Low risk:
Well controlled patients treated with diet alone, metformin or patients on thiazolidines e.g. Actos or Avandia, who are otherwise healthy.
Recommended changes to treatment regimen in patients with type 2 diabetes
1. Patients on diet and exercise control: No changes (modify time and intensity of exercise), ensure adequate water intake.
2. Patients on oral hypoglycemic agents: discuss the dosage and timing of your medications and or changing to insulin (for certain oral drugs) with your physician plus ensure adequate water intake.
3. Patients on insulin: discuss changing short acting or premixed insulin to long acting insulin with your physician, plus ensure adequate water intake.