By Dr Sunil Kumar Kota
Ramadan, the ninth month of Islamic Lunar Hijri Calendar, is marked by religious ritual of As-Saum (The Fasting). This is one of the five Pillars of Islam. Fasting starts from early dawn (Suhoor /Sehri) till sunset (Iftaar). Around 50 milion people across the globe practice fasting. The start of Ramadan advances 11 days every year and therefore for the next several years Ramadan in India is in the summer months and the length of fasts is very long (17 hours +) resulting in more onerous fast. During this period one has to abstain from eating or drinking. This ritual is compulsory for all mature followers of Islam, but exemptions are there for individuals who cannot fast due to various reasons.
What happens to our body during fasting?
After about eight hours of fasting, body starts using glucose stores to keep blood glucose levels normal. Later on it relies on fat as a source of energy. For most people, this is not harmful. Diabetic patients on tablets or insulin, are at risk of hypoglycemia (low blood glucose levels). Symptoms of hypoglycaemia include- shaking/ trembling, sweating, blurred vision, tingling of the lips, hunger, irritability/anxiety, confusion, dizziness, drowsiness, increased heart beating/palpitations. Rigorous exercise puts diabetic patients at increased risk of hypoglycemia. Therefore light to moderate exercise is recommended. This year, the fasts are long and the risks of hypoglycaemia and dehydration (lack of water) are high. Symptoms of dehydration include- thirst, reduced urination, dry mouth, lips and skin. Dehydration increases the risk of thrombosis or clotting of blood in the vessel. Symptoms may include pain, swelling and redness at the thrombosis site or heavy ache in the affected legs, prominent veins that stick out from skin and an itchy, skin rash or warm skin.
Additionally there is risk of high glucose levels following the larger meals eaten before and after fasting (at Suhoor/Sehri and Iftaar). Symptoms of high blood sugars include- weight loss, fatigue, thirst, increased urination, headaches, extreme tiredness, ketones in urine [pear drop smell on breath], loss of concentration. Testing blood glucose levels regularly is important and will keep diabetic patients safe while fasting. This will not break the fast.
Who are exempt from fasting?
Most people with health problems, such as diabetes are exempt from fasting. Choosing to fast is a personal decision that one should make with advice from diabetes team. For some people with diabetes, fasting can be dangerous and can cause problems to their health. Certain people and circumstances are exempt from fasting.
For example:
• Children (under the age of puberty)
• The elderly
• Those who are sick or grossly incapacitated
• Those with learning difficulties
• Travellers
• Pregnant, breastfeeding and menstruating, post delivery women
• Anyone who would be putting their health at serious risk by fasting, eg people who treat their diabetes with insulin and/or certain medications, people who have complications (damage to eyes, kidney or the nerves in hands or feet), or people who have poor control of their diabetes or diabetics who have experienced severe hypoglycaemia within 3 months of hypoglycaemia or have a history of recurrent hypoglycemia.
It is advised to try fasting for a couple of days in the month before Ramadan (the month of Shabaan) to check the capability for fasting without complications. Otherwise one can complete their duties by offering charity or providing food to the poor. Local Imam can provide more information about this. Alternatively fasting can be postponed to a later date, perhaps during the winter months. One must speak to doctor about diabetes treatment as early as possible before Ramadan
Do I need to wake up for SUHOOR (Sehri/ meal before dawn)?
Long hours of fasting increase the risk of hypoglycemia. Eating meal at Suhoor just before sunrise (and not at midnight), keeps glucose levels more balanced through the fast.
What type of food I can take at SUHOOR?
At Suhoor one should eat starchy carbohydrates and slowly absorbed foods, such as multigrain bread, oat-based cereals, basmati rice together with beans, pulses, lentils, porridge, fruits and vegetables. Fibre-rich foods are also digested slowly and include bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruits. Other foods which keep blood glucose levels more stable through the fast include bread, chapattis, barley, oats, grains and handful of nuts and dates, yoghurt, steam cooked boiled vegetables etc. A varied and balanced diet has to be continued. It is advised to avoid sugary and fatty foods (parothas, puris, pakodas, samosas). As with all meals, eat sensibly, do not over eat and remember to drink plenty of water. Home cooked food should be preferred over restaurant foods.
What type of food I can take at IFTAAR (meal after sunset)?
Ramadan is also about self-control and discipline with sensible and healthy eating during Ramadan. Overeating and eating the wrong foods (such as fried foods, foods high in fat and sugar) in large quantities will lead to weight gain and big increases and imbalances in blood glucose levels. Instead of heavy sehri or iftaar, it is better to have several small nutritious meals after breaking the fast. Portion sizes have to be moderate.
Fasting and high blood sugar levels increase the risk of dehydration. It is advised to drink plenty of fluids (sugar-free), particularly water and decaffeinated drinks, while breaking fast at Suhoor and after Iftaar.
Can I pray TARAWEEH?
Taraweeh refers to extra prayers performed by Sunni Muslims at night in the Islamic month of Ramadan. This is not compulsory. However, many Muslims pray these prayers in the night during Ramadan. Taraweeh can be a strenuous activity leading to dehydration or low blood glucose levels.
To avoid problems during Taraweeh
• eat starchy foods with Iftaar as they are digested slowly
• drink plenty of water following Iftaar
• take a bottle of water and glucose treatment with you to Taraweeh.
Safety tips
• Always have diabetes identification (medical bracelet) and carry glucose treatment with you.
• Test your blood regularly to monitor your glucose sugar levels. Additional testing is to be done, if you feel unwell during the fast.
• If your blood glucose is less than 60 mg/dl, end the fast immediately and treat the low blood sugar level.
• If your blood glucose level is below 70 mg/dl in the first few hours of fasting and you are on insulin or sulphonylureas (or any other medication that can cause hypoglycemia), do not fast.
• If your blood glucose level is higher than 300 mg/dl, end the fast immediately.
• If you become dehydrated, end the fast immediately and have a drink of water.
• If you start to feel unwell, disoriented, confused, if you collapse or faint, stop fasting and have a drink of water or other fluid.
• You should never stop your insulin, but you must speak to your doctor because you may need to change the dose and times of your insulin injections or oral tablets.
• If you have diabetes, smoking increases your risk of heart problems. Ramadan is a good time to build up your self-control and give up smoking.
If any of the above occurs, speak to your diabetes team before fasting again.
Dr Sunil Kumar Kota, MD (Med), DNB (Endo), Consultant Endocrinologist, DIABETES & ENDOCARE Clinic, Berhampur, Email: diab.endocare@gmail.com, Ph: +917749804401
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