To help diabetics manage their condition effectively during fasting and avoid complications, they should be aware of the following:
- Know the signs and symptoms of high and low blood sugar, and how to treat them.
- Monitor blood sugar regularly and the preferred times to measure it.
- Plan meals well, and nutritional guidelines related to fasting.
- Identify the suitable physical activity and the preferred times to do it.
- Manage medications before, during and after Ramadan in agreement with the healthcare provider.
- Know the necessary cases in which the patient must break the fast.
Symptoms of high and low blood sugar that can occur during Ramadan, and how to treat them:
Symptoms of low blood sugar (Hypoglycemia):
- Tension and anxiety.
- Rapid pulse and heart rate.
- Tremors, sweating, and shaking.
- Feeling tired, dizzy, and moody.
- Numbness in the lips.
Treatment of low blood sugar:
Low blood sugar should be treated, if your blood sugar level is 70 mg/dL or less.
If the diabetic patient is fully conscious, or semi-conscious, the (15-15-15 rule) must be followed:
- Drink 15 grams of fast-acting carbohydrates, equivalent to (about half a cup) of fruit juice, or a liquid containing sugar, such as: (half a cup of water dissolved in a tablespoon of sugar or honey).
- Then measure the blood sugar level within 15 minutes.
- If it is still low, repeat the previous step by drinking 15 grams (half a cup) of a drink containing sugar.
- The dose and test should be repeated until a normal blood sugar reading is reached.
- If the blood sugar reading reaches the normal range, this level should be maintained by offering 15 grams of a light meal, such as: (a cup of milk or a piece of bread).
If a diabetic patient is unconscious:
Immediate first aid should be provided by injecting the patient with a glucagon needle (intramuscularly), and do not try to put any other liquids in the mouth to avoid suffocation, then transfer him immediately to the nearest hospital.
When treating low blood sugar, consider the following:
Avoid foods that contain added fats, such as chocolate, because they do not raise blood sugar levels quickly, as fat slows down the absorption of sugar.
Always keep a piece of candy handy to eat immediately when you feel symptoms of low blood sugar.
Many people tend to want to eat as much as they can to feel better, and this can cause blood sugar levels to rise.
Symptoms of high blood sugar (Hyperglycemia)
- Extreme thirst.
- Frequent urination.
- Headache, feeling very tired.
- Blurred vision.
- Fruity breath odor.
- Feeling nauseous, or vomiting, and abdominal pain.
Treatment of high blood sugar
- Blood sugar can often be lowered by exercise.
- If your blood sugar is higher than 240 mg/dL, your urine should be checked for ketones. If ketones are present, you should avoid exercising, as exercising when there are ketones can cause your blood sugar to rise.
- Drink plenty of water.
- Stretch and rest.
- If you are using insulin, take the corrective dose as directed by your doctor.
- See your doctor if you have ketones in your urine.
Checking blood sugar levels during Ramadan:
- Checking blood sugar levels is an essential element of self-monitoring of blood sugar levels and controlling high and low blood sugar attacks that can occur during Ramadan because of changing diet and lifestyle.
- Some people have a misconception that pricking the skin to check blood glucose levels invalidates Ramadan fasting, but this is wrong. On the contrary, measuring blood sugar levels increases the ability of a diabetic patient to control it and continue fasting safely.
The number of times you measure your blood sugar level per day depends on several factors, including: the type of diabetes and the medications you are currently taking. However, in general, your blood sugar level should be checked several times to ensure good control during Ramadan.
Number of times to check blood sugar levels per day during Ramadan:
- Low- and moderate-risk diabetics are advised to check their blood sugar levels once or twice a day during Ramadan.
- High-risk diabetics are advised to check their blood sugar levels 3-4 times a day.
Blood sugar measurement times during Ramadan:
- It is important for all diabetics to measure their blood sugar levels after breakfast to detect high blood sugar levels after eating.
- Blood sugar levels should be checked when experiencing symptoms of low or high blood sugar, or when feeling unwell.
- Other times include Suhoor (before dawn), in the morning, at midday, in the afternoon, before breakfast, and two hours after breakfast.
Normal Diabetic Blood Sugar Level Target Ranges:
Blood sugar target ranges vary according to individual patients, but in general the following targets can be considered for most non-pregnant adults with diabetes.
- Hemoglobin A1C (less than 7%).
- Pre-meal blood sugar (80-130 mg/dL).
- 1-2 hours after meals (less than 180 mg/dL).
The patient must immediately break fasting when:
- Having a hypoglycemic episode (blood sugar < 70 mg/dL).
- If your blood sugar is rechecked within an hour and your blood glucose level is 70-90 mg/dL, you should also break your fast.
- If your blood sugar level is > 300 mg/dL.
- If you have symptoms of high or low blood sugar, dehydration, or acute illness.
Physical activity for diabetics during Ramadan:
- Strenuous exercise should be avoided, especially during the last hours of fasting (before sunset), as it may increase the risk of hypoglycemia or dehydration.
- Normal physical activity levels should be maintained during Ramadan, and Tarawih prayers can be considered part of daily exercise activities, as they involve bowing and standing.
Pre-Ramadan Medical Evaluation for Diabetic Patients
Medical evaluation: Before starting to fast, a diabetic patient must visit his healthcare provider at least 6 to 8 weeks before Ramadan. This visit provides:
- Assessing his health condition to determine whether he can fast or not.
- Controlling blood sugar, blood pressure, and fat levels within the target range before starting fasting.
- Providing advice to develop a modified nutritional plan that improves blood sugar levels during fasting, and helps those suffering from obesity lose weight during Ramadan.
- Developing an appropriate treatment plan by adjusting medication doses and times to suit fasting periods.
Factors that measure the risks of fasting for diabetic patients depend on:
- Type of diabetes.
- Diabetes control medications.
- Risk of hypoglycemia.
- Presence of other health problems, or complications of diabetes.
- Patient's experience of fasting in previous years.
Diabetics can generally be divided, according to the extent of their exposure to risks during fasting, into:
Groups at high risk when fasting:
- Type 1 diabetes patients.
- Type 2 diabetes patients with poorly controlled diabetes (glycated hemoglobin > 8.5%).
- Those who are unaware of hypoglycemic episodes.
- Severe and recurrent hypoglycemic episodes within 3 months prior to fasting.
- History of ketoacidosis or hyperglycemic coma within 3 months prior to fasting.
- Presence of other diseases besides diabetes, such as kidney disease or heart failure.
- Presence of an acute medical condition, such as (diabetic foot infection).
- Pregnant women with gestational diabetes, or a history of gestational diabetes, who are being treated with glucose-lowering medications.
Groups at moderate risk when fasting:
- Type 2 diabetes patients with moderately controlled diabetes (HbA1c 7.5%-8.5%).
- Pregnant women with gestational diabetes, or a history of gestational diabetes, who are controlled by diet alone.
- Diabetics who control the disease by basal insulin.
Low-risk groups when fasting:
- Patients with type 2 diabetes with good control of their diabetes (A1C < 7.5%).
- Patients with type 2 diabetes with good control of their diabetes on one type of medication.
Management of diabetic patients with chronic diseases and complications during Ramadan
Many diabetics suffer from complications, including heart disease, blood vessels, stroke, and kidney disease. This category is classified as a high-risk category when fasting during Ramadan, especially when fasting in an unsafe manner, which is due to the following:
- Eating large amounts of carbohydrates.
- Low levels of physical activity.
- Not drinking enough fluids.
- Irregular medication intake.
Therefore, the following guidelines should be followed for safe fasting for these groups:
- Conduct a comprehensive evaluation by a healthcare provider and specialist doctors, such as a cardiologist, neurologist, and nephrologist, to assess the health status before fasting.
- Obtain nutritional guidance and modifications, change the medication plan, and follow-up, according to the individual risk assessment.
- Drink sufficient fluids during the period between Iftar and Suhoor.
- Monitor blood sugar carefully and conduct weekly reviews in coordination with the healthcare provider, to assess the health status during fasting.
- For kidney patients, foods that are high in potassium and phosphorus should be avoided