Veteran advice about safe fasting for people with diabetes
by Farah El Akkad
Fasting is challenging enough for those in perfect health, as they try to manage hunger, thirst and flagging energy levels. But for those with diabetes, who must actively manage their blood sugar every day, fasting is more than just a religious obligation ― it’s a serious health concern.
Ghada Helmy has been coping with diabetes for 23 years. During Ramadan, she says, “Even if I start the day well, I could end up having to break my fast.”
Dr. Ahmed El-Sabawy, a specialist in diabetes at Kasr Al-Aini hospital and a member of the Arab Association for the Study of Diabetes and Metabolism, explains that one of the biggest concerns he hears from diabetic patients is “Will I be able to fast?” The answer depends on the type of disease. Type 1 diabetics, who rely on insulin injections, should probably not fast, but those with Type 2 diabetes can, with careful management, successfully fast without endangering their health. (See box “What is Diabetes?” for details.)
Careful management should start with a doctor’s visit about two months before Ramadan to evaluate and stabilize blood sugar levels. Because of the month-long changes in meal times and daily lifestyle during Ramadan, diabetic patients should learn what to do and what not to do.
Monitoring blood sugar levels before starting the fast (suhour time) and, even more important, right after breaking the fast is crucial, El-Sabawy says, “because it helps the patient determine the amount of carbohydrates they should eat.”
And there’s no overindulging in the super-sweet Ramadan treats. Helmy explains that at iftar, “I try to eat more of salads and vegetables and perhaps soup which is especially filling without raising my blood sugar much.” To prepare for the next day’s fast, she says she “eats complex carbohydrates at suhour like beans or hummus and lots of yogurt to keep thirst at bay and of course plenty of water.”
That doesn’t mean sweets are off the table entirely. Helmy recommends making the halawiyat at home and modifying the recipe to cut back on glucose and fats. For example, white sugar can be replaced with diabetic-safe sugar. Honey is a good substitute for sugar-based syrups, as it has just as many calories but does not cause spikes in blood sugar levels. To reduce fats, Helmy uses cooking oils instead of butter.
With regular monitoring, diabetics can determine if they will be able to continue the fast or not, and which types of food they need to eat, which will help avoid any problems with fasting. Helmy admits that she always has problems with lack of energy in Ramadan. “I always fast till the 15th of the month,” she notes, “then I must stop for a couple of days to regain my strength.”
In response, El-Sabawy stresses that patients should carefully monitor their energy levels along with their weight: “If they are losing weight, they shouldn’t be fasting.”
Moderate exercise, however, is actually good for regulating blood sugar. The doctor advises diabetic patients to take a 30 minute walk daily, adding “just going to the taraweeh prayers will do.” The doctor explains that taraweeh prayers provide good exercise and at the same time gives the mind a spiritual boost that a diabetic person can greatly benefit from.
“The number-one enemy [for diabetics] is stress,” El-Sabawy says “Ramadan provides a stress-free atmosphere for diabetics and helps them enhance their psychological health.” He adds that studies have proven that “Meditation and prayers during Ramadan tend to lower blood pressure and provide overweight diabetics with a good source of exercise.”
Ultimately, the diabetic is in the best position to decide if he or she is able to fast. El-Sabawy notes, “Patients with poor control of blood sugar levels should not attempt to fast.”
According to Dar El Ifta, diabetic patients are permitted to break their fast or not fast at all, if fasting will prolong their illness, leads to a worsening of their symptoms or affects their general well being.
Reflecting on her life with the disease, Helmy stresses the importance of being true to your health. “Avoid any pressure from yourself or others to continue with your fast,” she says. “If you feel unwell during your fast, test your blood sugar levels and if within normal limits attempt to continue until sunset. However, do not feel forced to continue fasting because as it could be fatal for some diabetic patients.”
Risks of Fasting
Dr. Ahmed El-Sabawy says diabetic patients are at greater risk for complications during the fast.
Hypoglycemia: Dangerously low blood sugar due to insulin or medication overdose or not eating enough carbohydrates or sugar after taking medication. Symptoms include dizziness, excessive sweating and blurry vision.
Hyperglycemia: Dangerously high blood sugar levels. Symptoms include frequent urination, fatigue and headache.
How to avoid either condition:
• Consult your doctor at least 2 months before the start of Ramadan to stabilize blood sugar levels.
• Follow a balanced diet. Refrain from sweets high in sugar and eat whole fruit, not fruit juices. Eat foods with a low glycemic index, such as brown bread or fruits rich in fiber.
• Test your blood sugar levels at least four times a day to make sure it is stable.
Dehydration: Excessive loss of body water.
How to avoid the condition:
• Avoid heavy exercise before breaking your fast.
• Drink a lot of water at sohour.
• Avoid salty foods such as pickles at suhour.
What is Diabetes?
People with diabetes do not process glucose properly because their bodies do not produce enough insulin, a hormone that controls blood sugar levels. The two main variations of this treatable but incurable disease are:
Type 1: Patients do not produce insulin at all, which makes it hard for them to maintain stable blood sugar levels. Symptoms include frequent urination, unusual thirst, extreme hunger, unusual weight loss, extreme fatigue and irritability.
Patients must continually monitor their blood sugar levels and insulin injections or use insulin pumps every day to control the disease. They also should keep to a regular schedule for eating and exercise, making it tremendously difficult or almost impossible to fast.
Type 2: Patients produce either not enough or too much insulin in their bodies. Symptoms include any of the type 1 symptoms, frequent infections, blurred vision, cuts/bruises that are slow to heal, tingling/numbness in the hands/feet, and recurring skin, gum or bladder infections.
Patients can often control their disease through diet, exercise and oral medication or insulin injections. With firm monitoring of their blood sugar levels, these patients may be able to fast the whole month of Ramadan.
A diabetic friendly Ramadan menu
Dr. Ahmed El-Sabawy, a specialist on diabetes, offers a model Ramadan menu of food types and portion sizes suitable for diabetics.
Soup: Tomato, vegetable and chicken soups are allowed, but avoid full-cream or flour-based soups
Carbohydrates: 8 tablespoons of either rice, pasta or two small boiled potatoes
Vegetables: One plate of any type of vegetables, but avoid peas and potatoes
Protein: 150 grams of grilled or boiled fish or meat
Drinks: Diet sodas or unsweetened fruit juice (1 cup)
After Taraweeh prayers
Choose one of the following dessert options:
1 fruit salad bowl
Khoshaf, comprising of 1 date, 1 apricot, 1 prune and a small handful of nuts
Suhour (all of the following)
2 pieces of whole wheat toast + 1 slice of rumi or cheddar cheese
4 tablespoons of ful
1 container of yogurt
1 portion of fruit
Plenty of water