Are you living with diabetes and planning to fast? Diabetes Educator and Accredited Practising Dietitian Shannon Lin, and Accredited Practising Dietitian Lina Breik, offer practical tips and advice for a safe and healthy Ramadan.
Consider your risk
The decision to fast is personal, and your health care team has a duty of care to respect your commitment and ensure your safety.
Fasting, refraining from using medications, insulin and drinking water affects your blood glucose levels (BGL) and can lead to potential risks including high BGL (hyperglycaemia), low BGL (hypoglycaemia or hypo), dehydration, blood clots and diabetic ketoacidosis (DKA).
You may be advised not to fast if your diabetes management is unstable prior to Ramadan, you have type 1 diabetes, you’re hypo unaware, pregnant, unwell, or will be performing intense physical labour.
“It is very important to discuss your Ramadan plan with your doctor and diabetes team one to two months before,” advises Lin.
A pre-Ramadan assessment is an opportunity to review your blood pressure, BGL and lipids, learn of any potential risks of fasting, discuss monitoring and how to treat a hypo or manage high BGL, and prescribe any Ramadan-specific changes in the dose and/or timing of your medication or insulin regime.
“A hypo is a medical emergency and therefore, treatment would entail breaking your fast,” says Breik. Visiting your doctor to adjust your insulin regime before you begin fasting can help you avoid this.
Safety tip: Never stop taking your insulin or your diabetes medications. Speak with your diabetes doctor or nurse about how to change the time and dose during Ramadan.
Check your blood glucose levels regularly
“Your blood glucose levels can be affected by fasting, dehydration, prayer activity and feasting after sunset,” explains Lin.
Checking your BGL more frequently is encouraged during Ramadan, with the Diabetes and Ramadan International Alliance reassuring that pricking the skin for blood glucose testing does not invalidate the fast.
How often to check depends on the type of diabetes you have, and your medication or insulin regimen. Speaking with your diabetes healthcare team can assist you with this.
Safety tip: If you feel unwell at any time during Ramadan, check your BGL and be prepared to break the fast to treat a hypo (BGL less than 4mmol/L) – or manage hyperglycaemia (BGL more than 15mmol/L).
Eat well after Iftar
“During the month of Ramadan, a person’s eating pattern endures a major change,” explains Breik. Longer gaps between meals and feasting after iftar can lead to greater swings in blood glucose levels.
“Proper nutrition is very important to help prevent any health problems that may arise from inappropriate food choices or overeating.”
Here’s her top four tips for a healthier Ramadan:
“Break your fast with a ‘sunset snack’ of two dates, a cup of water and a bowl of soup,” says Breik. Two dates are a good serve size (½ carbohydrate exchange) and they are a low GI choice. “This is a Prophetic tradition and will provide an instant energy boost and hydration to help settle your hunger to prevent overeating at the main meal.”
Hydration, hydration, hydration!
“Make sure you drink as much fluid, preferably water, as possible,” says Breik. “A good technique to help you remember your fluids is to “drink two by the hour” – meaning two cups of water (250mls = 1 cup). Five hours past sunset, you would have consumed two and a half litres of fluid keeping you very well hydrated.”
The healthy plate model applies at Ramadan
Using the healthy plate model for your main meal helps you maintain a good balance of carbohydrates (quarter of your plate), protein (quarter of your plate) and vegetables (half a plate), and prevents you from overeating.
“Two hours after the dinner meal, it is normal to feel hungry,” explains Breik. To appease your hunger and prevent overeating traditional sweets and high BGLs after eating, choose one or two healthy options:
A 100-200g of low fat yoghurt
A wholegrain salad/cheese/tuna sandwich
1-2 pieces of fresh fruit
A cup of low fat milk
A handful of nuts
1-2 cups popcorn (unsalted and unbuttered)
4 Vitawheat biscuits with low fat cheese or peanut butter