04-JUN-2016: Professor Jamal Ahmad, former Director, Rajiv Gandhi Centre for Diabetes and Endocrinology, JN Medical College, Aligarh Muslim University has prescribed some basic principles to be followed as well as measures to be adopted to prevent the complications that may occur during fasting in the month of Ramadan.
Professor Ahmad informed that in the world more than 50 million people with diabetes fast during the holy month of Ramadan, which is meant to inculcate discipline in an individual rather than to impose excessive hardship and in fact, the Holy Quran specifically exempts the sick from the obligation of fasting in case it cast an adverse effect on his health. Professor Jamal further confirmed that People with diabetes fall in the category of those exempted from fasting as it carries a risk of acute metabolic decompensation (hypoglycaemia and hyperglycemia). Notwithstanding this relaxation, many diabetic patients insist on fasting during Ramadan, thereby giving rise to a medical challenge for them and for the consulting physicians as well, he added.
Highlighting the basic principles to be adopted by diabetic patients while fasting, Professor Ahmad said that an individual assessment for overall wellbeing and control of blood glucose, blood pressure and lipids should be done 30 to 60 days prior to the start of Ramadan with proper emphasis on preventing the occurrence of hypoglycaemic events. He informed that that essential elements necessary to render fasting safe includes glucose monitoring during fasting and non-fasting hours, appropriate meal choices to avoid post meal hyperglycemia and proper planning of meal to avoid hypoglycaemia and dehydration.
"Proper advice on the timing and intensity of physical activity during fasting should be taken" said Prof Ahmad while suggesting that a person must immediately break the fast if blood glucose goes below 70 mg/dl or exceeds 300 mg/dl. He also suggested that fasting should be avoided on "sick days". Prof Ahmad said that patients having Type 1 diabetes and taking 4 insulin injections per day should not fast while those with Type 2 diabetes taking Metformin alone can undertake fast safely.
While referring to the prevention of complications, Professor Ahmad suggested daily recording of weight and diet intake, taking medications regularly as instructed, undertaking moderate physical activity particularly in the evening, avoiding overeating and minimizing consumption of sweet or fatty foods and testing blood glucose before and 2-hours after Iftar, before Sahar and at mid day. He further suggested breaking the fast and seeking medical help if a complication occurs.
Professor Ahmad said that limitation of food intake during the fast, especially if prolonged, is a cause of dehydration particularly in those who already have compromised renal functions. All the medicines for blood pressure and cholesterol should be continued as usual, he added.