Diabetes control during Ramadan

Patient education material
Dr. Balaji Venkatachalam
MBBS, D.Diab (MMC), DNB (Internal Medicine), MRCP (UK), IFCCM, EDIC
Physician – Intensivist – Diabetologist
drbalajivenkatachalam.com
All healthy individuals may be able to fast safely with proper diabetes education and health
precautions.
Pre-fasting preparation and counseling…
Ideally, counseling and preparation for Ramadan fasting should start 1-2 months before the
fasting. You will need a structured Diabetes education program to successfully and safely
undertake the fasting.
Discuss with your Physician about optimizing sugar control, tips to avoid hypoglycemia and
any other concerns you have.
Fasting is not advisable or safe for the below group of patients…
– Pregnant women
– Breast feeding women
– Frail individuals with heart, lung, liver or kidney problems
– Patients receiving Dialysis treatment
– Elderly patients with hypoglycemic unawareness (They may not develop high heart
rate, giddiness or sweating in response to low blood sugars)
– Children
– Type 1 diabetic patients
– Patients with brittle diabetes i.e. fluctuating blood sugars (very high and low sugars)
– Patients who are living alone or having poor social support
– Patients with history of serious hypoglycemia (requiring medical assistance or
hospital admission) within the past 3 months
– Patients with history of serious DKA (Diabetic keto acidosis) requiring hospital
admission in the past
– Type 2 diabetic patients on high dose of insulin with no prior experience with fasting
– Type 2 diabetic patients on gliflozins / SGLT2 inhibitors (canagliflozin, dapagliflozin,
empagliflozin). It is recommended to change to alternate diabetic medications, if fasting is
planned. You should hydrate yourself properly, if you are on these medications.
With proper diabetes education, fasting may be safely done for the
following group of patients…
– Type 2 diabetic patients without comorbids (serious heart, liver or kidney problems)
– Diabetic patients taking only tablets like metformin, gliptins (sitagliptin, vildagliptin,
teneligliptin), glitazones (pioglitazone) or low dose insulin
What are the risks of fasting?
If fasting is not done properly with appropriate precautions, multiple complications can occur.
– Hypoglycemia (low blood sugar)
– Hyperglycemia
– Diabetic keto acidosis
– Dehydration and low blood pressure
– Increased risk of thrombosis (blood clots in legs as well as other parts of body due to
dehydration)
When to check blood glucose during Ramadan fasting?
– Pre-dawn meal
– Morning
– Mid-day
– Mid-afternoon
– Pre-sunset meal
– 2 hours after Iftar meal
– Any time of the day when you feel tired, unwell or thirsty
Have a glucometer handy and check finger prick – blood glucose when you feel tired
or sweating profusely.
Diet advice during fasting
– Use Ramadan as an opportunity to adopt healthier food choices and life style
– Drink plenty of water, thin butter milk or (non-sugary) homemade fruit juices. Hydrate
yourself well, before and after the fast
– Avoid excess fried foods (samosas, papads, Puri)
– Avoid white sugar based foods
– Minimize consumption of caffeine.
– Try to have plenty of fresh fruits and vegetables/salads.
– Prefer to take high-fiber and starchy foods
(Millet chapatis, oat-based cereals, grains, seeds, beans and pulses)
– Do not consume excessive dates (This will increase blood sugars sharply)
A properly undertaken fasting after appropriate diabetes education not only provides positive
health benefits, but also immense psychological and spiritual well being.
Discuss with your Physician and Registered Dietician about safe ways to fast during
Ramadan.
drbalajivenkatachalamcritic@gmail.com