Preparation of diabetics for Ramadan fasting
Fasting during Ramadan is a great worship. But it may be challenging for some people living with chronic medical conditions like diabetes. Although Islam accepts valid reason for not fasting, some people focus on fasting without prior preparation and consultation with doctors making the condition more challenging. However, with appropriate preparation and changing schedule for medication, many diabetics can perform fasting without any complication. During assessment by doctors, the patients and family should receive the necessary education concerning self-care, including signs and symptoms of hypoglycemia (a condition when blood sugar falls below normal), blood glucose monitoring, meal planning, physical activity, medication administration and management of acute complications. The effect of fasting during Ramadan on rates of hypoglycemia in patients with diabetes is not known with certainty. Patients with type 1 diabetes (childhood diabetes treated with insulin) who have a history of recurrent hypoglycemia or who are poorly controlled are at very high risk for developing severe hypoglycemia. On the other hand, an excessive reduction in the insulin dosage in these patients may place them at risk for hyperglycemia (high sugar in blood) and its complication e.g. diabetic ketoacidosis (when excess ketone body, a kind of acid accumulates in blood). Limitation of fluid or dehydration can make it more complicated. Hypo- and hyperglycemia may also occur in patients with type 2 diabetes (adult onset diabetes) but generally less frequently and with less severe consequences compared with patients with type 1 diabetes. Very elderly patients with type 2 diabetes may be at especially high risk. It is strongly recommended that patients specially who are at risk should monitor their blood glucose levels during fasting and can take insulin if blood sugar level shows high. Muslim scholars recommended that blood tests for glucose monitoring and taking insulin do not invalidate the fasting of Ramadan. All patients should understand that they must always and immediately end their fast if hypoglycemia occurs. Fasting should also be broken if blood glucose reaches 3.9 mmol/l in the first few hours after the start of the fasting. A patient's decision to fast should be made after ample discussion with his/her physician concerning the risks involved. Patients who wish to fast should undergo pre-Ramadan assessment and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, dosage, timing of medications. Close follow-up is essential to reduce the risk for development of complications. ...............................................
The writer is a physician doing his MD coursework in Endocrinology at BIRDEM Academy, Shahbag, Dhaka. Email: selimshahjada@gmail.com
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