DEAR MAYO CLINIC: My family observes Ramadan, the Muslim holy month which involves fasting. However, I was recently diagnosed with diabetes. Another relative with diabetes told me that it would not be possible for me to fast. Do you have any advice on how I can safely participate in ritual fasts during this sacred time? Is there anything I should change to suit my condition?
ANSWER: When living with diabetes, your diet is an essential part of your treatment plan. Patients with diabetes need to pay more attention to the foods they eat and to details, such as calories, total carbohydrates, fiber, fat, salt, and sugar. All of these could have the potential to affect their blood sugar levels.
While some people choose not to eat for a period of time, or to fast, for religious reasons, such as from dawn to sunset during the Islamic holy month of Ramadan, fasting is something you should not. do without prior planning. I recommend that you discuss with your health care team the specifics of your medical condition and the details surrounding the vacation and desired fast.
There are potential risks of complications from fasting, such as low or high blood sugar and dehydration. Generally, people with well-controlled type 2 diabetes, who manage their diabetes with medications and lifestyles, can fast during Ramadan, as long as they can adjust their medications under the guidance of their healthcare team.
However, some people may be at high risk of complications if they fast during Ramadan. This would be someone who has 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 hypoglycemia or diabetic ketoacidosis
• History of recurrent hypoglycemia or ignorance of hypoglycemia
• Conditions such as severe kidney disease or vascular complications
• Diabetes and pregnant
Your healthcare team may suggest that you avoid fasting if you are at high risk for complications. If the decision is made to fast, your healthcare professional and diabetes care team will likely provide information about managing your diabetes and adjusting medications or insulin doses while fasting.
The most important thing to remember if you plan to fast during Ramadan is that you will need to closely monitor your blood sugar levels and you should educate your family members to be alert for signs of low blood sugar, including:
• An irregular or rapid heartbeat
• Pale skin
• Tingling or numbness of the lips, tongue or cheeks
As hypoglycemia worsens, signs and symptoms may include:
• Confusion, abnormal behavior or both, such as inability to perform routine tasks
• Visual disturbances, such as blurred vision
• Loss of consciousness
Low blood sugar, also called low blood sugar, requires 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 lower should serve as a warning sign of hypoglycemia. But your numbers may be different, so it will be important to have a conversation with your healthcare professional about which number is too low for you.
Likewise, hyperglycemia is something that needs to be monitored. Discuss with your healthcare team suggestions for specific foods, drinks, and exercises during the month, and monitor your body’s response. You must be prepared to adjust medication doses as needed and, most importantly, be prepared to break the fast if something goes wrong.
Fasting during Ramadan can be practiced safely if you and your family take the time to understand the risks and identify the best way to manage your routine so that you can follow the recommendations of your healthcare team. — Dr. M. Regina Castro, Endocrinology, Mayo Clinic, Rochester, Minnesota