Ramadan is a month-long period in the Islamic faith during which Muslims abstain from eating and drinking between dawn and dusk in order to enhance spiritual awareness and self-discipline and strengthen the relationship with God. They pray during the day and then, at night, they feast to break the fast.
Ramadan occurs 10 to 11 days earlier every year; the timing is based on the cycles of the moon (the lunar calendar). This year, Ramadan started on May 5 and will last through sundown on June 4.
Practicing Muslims who are healthy and who have reached puberty fast during Ramadan, which means no eating or drinking from sunrise to sunset. In addition to avoiding food and drink, however, people also must avoid taking oral medications, smoking, sexual activity, swearing and arguing. Many Muslims also avoid alcohol during Ramadan.
Healthy Muslims are encouraged to fast during this time. But according to religious scripture, some people are exempt from fasting. These include children, the elderly, pregnant and breastfeeding women, women who are menstruating, people who have acute or chronic illnesses, and people who are traveling.
Diabetes is considered to be a chronic condition; if you have type 1 diabetes or type 2 diabetes and take insulin, you do not need to fast. Likewise, you can be exempt from fasting if your diabetes is not well managed. If you would like to fast during Ramadan, it’s important to talk with your health-care team — ideally, a few months before the start of Ramadan. Your provider or diabetes educator will address possible risks of fasting, as well as review your diabetes treatment plan and suggest changes, if necessary. In addition, you’ll likely need guidance on eating, exercising and checking blood sugars during this time.
The two main risks of fasting are hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose). If you take insulin or certain types of diabetes pills, such as sulfonylureas, you are at risk of hypoglycemia. It’s important to limit physical activity while fasting and to aim to be active after sundown. If you stop taking your diabetes medication, you are at risk of hyperglycemia, even if you aren’t eating. In addition, you may experience hyperglycemia after the fast is broken, as there may be the tendency to overeat, along with eating too many sweets and other foods high in carbohydrate. It’s even possible to gain weight during Ramadan!
Other risks to be aware of during Ramadan are dehydration (especially during hot weather) and, for those with type 1 diabetes, diabetic ketoacidosis, or DKA, which can occur if you stop taking insulin.
Absolutely. However, you will likely need to change when you take your medication, as well as your dose. For example, your medication regimen may be changed so that you take your dose or doses at Suhoor (the first meal that is eaten at dawn) or at Iftar (the second meal that is eaten at sunset).
When it comes to insulin, insulin doses for those with both type 1 and type 2 diabetes will need adjusting. A decrease in basal (long-acting) insulin is usually needed, whether the basal insulin is injected or infused with an insulin pump. Bolus, or pre-meal, insulin doses will need adjusting, too.
The International Diabetes Federation (IDF) and Diabetes and Ramadan (DAR) International Alliance have published guidelines for health-care providers that can help your doctor know how to adjust your medication.
While many religious leaders and medical experts advise people with type 1 diabetes not to fast during Ramadan due to a higher risk of DKA and hypoglycemia, there are many people with type 1 diabetes who choose to fast, especially those who live in Muslim countries. However, you should not fast if you have the following:
• Frequent hypoglycemia
• Hypoglycemia unawareness
• Diabetes that isn’t well managed
Also, it’s not safe for you to fast if you aren’t taking your insulin as prescribed or if you’re not willing to check your blood glucose frequently.
Taking insulin does not “invalidate” the fast, so it’s extremely important to take your insulin as prescribed, with the understanding that your usual insulin regimen may need to be changed during Ramadan.
Checking your blood sugars with a meter or using continuous glucose monitoring does not break the fast. In fact, it’s extremely important to keep tabs on your glucose levels during Ramadan. If your glucose is low (less than 70 mg/dl) or high (above 300 mg/dl), you will need to break the fast and treat accordingly. You may also need to break your fast if you become dehydrated or ill.
Ramadan is typically known for fasting, but, as Melinda Maryniuk, RD, Med, CDE puts it, “it’s actually a time of feasting.” During Ramadan, people eat a meal before sunrise called Suhoor. This meal may be similar to breakfast, but may also consist of more “dinner-like” foods. After sundown, the fast is broken with Iftar, a meal that usually consists of dates and water or milk, followed by dinner.
For both Suhoor and Iftar, Maryniuk recommends that you aim to choose a balance of whole grains, fresh fruit, vegetables and yogurt, which contain carbohydrate and can help lower the risk of hypoglycemia. These meals should also contain protein from fish, lean meat, poultry, eggs, cheese or legumes and healthy fats, such as vegetables oils and nuts. Protein and fat are less likely to cause “spikes” in blood sugar and can help keep blood sugar levels more stable. Plus, foods that contain protein and fat can keep you from feeling too hungry.
Go easy at Iftar, though. After fasting for hours, no doubt you’ll be hungry and it’s easy for portions — and food choices — to be less than healthy. Limit fatty and fried foods, as well as foods high in sugar. These can raise blood glucose levels and lead to weight gain. Remember that Ramadan is about self-control and discipline. If you have questions about meal planning, ask your doctor for a referral to a registered dietitian.
Drink plenty of water or other non-caloric beverages during non-fasting hours to stay hydrated. Choosing vegetables, such as cucumbers, green peppers and tomatoes, and fruits such as watermelon, cantaloupe and strawberries, that are high in water and can also boost hydration.
Yes, staying physically active during Ramadan is encouraged! But it’s best to limit physical activity during the hours of fasting due to the risk of hypoglycemia. Instead, plan exercise for two hours after the Iftar meal. Also, going to Taraweeh prayers during Ramadan “counts” as physical activity.
Remember to plan ahead and talk with your health-care team about Ramadan and whether it’s advisable for you to fast. If you cannot or choose not to fast because of your diabetes or other health reasons, you may be able to make a “fidya” payment for each of the days missed — this payment is meant to feed a person in need.
If you do fast during Ramadan:
• Have a plan for when to take your diabetes medicine, as well as how much. Share the guidelines from the International Diabetes Federation, mentioned above, with your health-care team if they are uncertain how to adjust your diabetes treatment plan.
• Check your blood sugars often; if your blood sugar goes below 70 or above 300 (or the targets recommended by your doctor), you will need to stop your fast.
• Always keep treatment for low blood glucose, such as glucose tablets or glucose gel with you at all times.
• If you become dehydrated or feel ill, end the fast and drink water.
• During Suhoor and Iftar, eat a variety of healthy foods that provide a balance of carbohydrate, protein and fat.
• Drink plenty of water after Iftar.
Are you a health-care provider interested in learning more about treating patients during Ramadan? Download our free guide.
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