Can people with Type 2 diabetes safely attempt Ramadan fasting or should they avoid this practice? And if they do go ahead and fast, how can it be done safely?
This is an even more relevant question in the MENA region and throughout the UAE, where the total prevalence of diabetes is high: 16.3 percent, compared to 9.3 percent worldwide, according to a report by the International Diabetes Federation in 2020.
According to a 2019 study in Dubai, the prevalence of diabetes is 13.7 per cent; 11.5 percent known diabetes and 2.1 percent newly diagnosed. A dn diabetes among Dubai Emiratis is much higher than Dubai expats (19.3 vs. 12.4 percent).
When you have diabetes, your diet is a vital part of your treatment plan. Patients with diabetes need to be more mindful about the foods they eat at all times, paying attention to the details, such as calories, total carbohydrates, fiber, fat, salt and sugar. All of these could have the potential to affect their blood sugar levels.
There are potential risks of complications from fasting, such as low or high blood sugar and dehydration. Typically, a person with Type 2 diabetes that is well-controlled, who manages their diabetes with medications and lifestyles, may be able to fast during Ramadan, so long as they can adjust their medications under the guidance of their care team.
Individuals who may be at high risk of complications from fasting during Ramadan would be those who have one or more of the following:
- Type 1 diabetes
- Type 2 diabetes with poor blood sugar control or taking certain types of insulin
- Recent history of severe low blood sugar or diabetic ketoacidosis
- History of recurring low blood sugar or unawareness of low blood sugar
- Conditions such as severe kidney disease or blood vessel complications
- Diabetic and pregnant
A health care provider may suggest avoiding fasting all together in these cases. Should someone with any of these conditions decide to fast, they will need to closely monitor for signs of low blood sugar and have family members, friends and colleagues do the same:
- An irregular or fast heartbeat
- Pale skin
- Tingling or numbness of the lips, tongue or cheek
As low blood sugar worsens, signs and symptoms can include:
- Confusion, abnormal behavior or both, such as the inability to complete routine tasks
- Visual disturbances, such as blurred vision
- Loss of consciousness
Low blood sugar, also called hypoglycemia, needs immediate treatment. For many people, a fasting blood sugar of 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L), or below should serve as an alert for hypoglycemia. But numbers vary, so it’s important to know your numbers before embarking on a fast.
Likewise, high blood sugar is something that needs to be watched. A health care provider can advise on specific food, drink and exercise during the Holy Month, and adjusting medication doses as appropriate. More importantly, anyone in this situation needs to be ready to stop fasting if there is an issue.
Fasting during Ramadan can be done safely as long as everyone involved takes the time to understand the risks, identify the best way to manage care and carefully follow the care team’s recommendations.
• Dr M Regina Castro is a consultant in endocrinology at the Mayo Clinic in Rochester, New York.