Halal Health
@ Halal | May-June . 2022
Decreased food intake a well-known risk factor There should be proper adjustment with anti-diabetic medications , both oral and injectable
BY PROF DR NORLAILA MUSTAFA
FASTING DURING Ramadan is one of the five main pillars of being a Muslim . Most Muslims are passionate about fasting during this month . There are about 1.9 billion
Muslims globally , and the number keeps increasing by about three per cent yearly . In Malaysia , about 62 per cent of the population are Muslims .
Although the Quran exempts sick people from the duty of fasting , many Muslims with diabetes are keen to fast . People with diabetes need to discuss it with their doctors before deciding to fast .
It includes understanding their diabetes control , the risk of fasting to their health , how to reduce this risk and whether the risk is too high to perform the Ramadan fasting . If someone cannot complete the Ramadan fasting for health reasons , they should discuss with the Imam and ask for advice about an alternative to fasting .
The average Ramadan fasting in Malaysia is about 14 hours , which means abstaining from eating and drinking after suhor ( sunrise ) until iftar ( breaking the fast at sunset ). People with diabetes are encouraged to drink a lot of water after breaking their fast to prevent dehydration .
Decreased food intake is a well-known risk factor for developing hypoglycaemia ( low blood sugar , < 4.0 mmol / L ), especially when there is no proper adjustment with antidiabetic medications , both oral and injectable .
Other known risks associated with fasting among people with diabetes are hyperglycaemia ( high blood sugar ) and thrombosis ( occlusion of the vessels due to the formation of blood clots ).
Population-based studies ( EPIDIAR Study ) have shown that both risks of hypo and hyperglycaemia are high during fasting Ramadan in people with diabetes . It is true if the diabetes is not well controlled . Proper education about fasting is not given to them .
Severe hyperglycaemia will also lead to dehydration
Symptoms of low blood sugar or hypoglycaemia are lightheadedness , sweating , feeling tired , feeling hungry , tingling lips , feeling shaky or trembling and a fast or pounding heartbeat ( palpitations ).
In severe cases , hypoglycaemia can also cause seizures , loss of consciousness , and coma .
Hyperglycaemia during Ramadan fasting can be due to excessive reduction of medication dosages to prevent hypoglycaemia . An increase in food or sugar intake during nonfasting hours ( after Iftar until Suhor ) also had significantly higher severe hyperglycemia rates .
Therefore , patients with diabetes who want to observe Ramadan fasting must be adequately educated by their doctor on the medication dosage adjustment and blood sugar monitoring .
Symptoms of hyperglycaemia include being extremely tired , and thirsty , passing a lot of urine , blurred vision , dryness of mouth and skin and headache . Severe hyperglycaemia will also lead to dehydration and can cause acute
kidney failure .
People with diabetes tend to take the importance of monitoring blood sugar for granted and only do so once they have symptoms of hypo or hyperglycemia . The blood sugar monitoring should be done as often as possible during fasting , and be sure to have the monitoring strips available .
If the blood sugar drops below 4.0 mmol / L and yet there are no symptoms of hypoglycaemia , you must break your fast . Failing to do so will be detrimental to your health as the blood sugar can drop further and lead to a coma .
Hypoglycaemia occurs quite often , as people with diabetes will still take diabetic medications . Similarly , if your blood glucose is high and you have symptoms of hyperglycaemia , as mentioned above , you must break your fast too .
Take oily foods or fried foods in moderation
It is essential not to skip the Suhor meal just before dawn . You are encouraged to drink a lot of water to prevent the risk of dehydration . Healthy eating such as taking high fibre foods like cereal , oats , or brown rice is more slowly absorbed and has a low glycemic index .
This will help maintain your blood sugar within a normal range during fasting . A good source of protein like dhal and beans is also high in fibre and good for health .
Although it is an early morning meal , combining your carbohydrate intake with fruits and vegetables is important for your health and blood sugar control .
Breaking fast at sunset ( Iftar ) with dates is Sunnah encouraged in Islam . Dates are high in fibre but also a rich source of carbohydrates . You can only take two large dates combined with a large glass of plain water to maintain your sugar level .
Avoid sugary drinks and reduce all the unhealthy desserts during iftar as this will quickly raise your blood sugar . Taking oily foods or fried foods in moderation is vital as this will lead to weight gain despite fasting a whole month during Ramadan .
Watching your salt intake is also important to maintain your blood pressure within the normal range . Remember , you are not only to keep your blood sugar level , but your overall health is of utmost importance .
Lastly , anti-diabetic medication adjustment , either oral tablets or injectables , is important to prevent hypoglycemia during fasting . It would be best to discuss this with your doctor , especially the insulin dose and injection timing .
Although it is mandatory ( wajib ) for all Muslims , Fasting during Ramadan is not supposed to be detrimental to your health .
Prof Dr Norlaila Mustafa is Deputy Dean ( Postgraduate ), Faculty of Medicine and Senior Consultant Physician and Endocrinologist , Universiti Kebangsaan Malaysia Medical Centre .