When it comes to your body's sugar levels, you don't want any spikes or dips. Unfortunately for diabetics and those with insulin resistance, they're susceptible to both of these. If the wrong kinds of foods are eaten, or if they go without eating for long periods of time, bouts of hypoglycaemia (low blood sugar), or hyperglycaemia (high blood sugar) occur. That means they need to eat meals regularly to maintain stable levels. Sounds simple enough — until Ramadan, that is.
So what can happen to diabetics when they stop eating? In the worst-case scenario, they could fall into a coma and die. However, doctors and nutritionists say that taking the right precautions will ensure a safe fast during Ramadan,
"Generally, fasting is not recommended for diabetics," says Dr Bahaeldeen Laz, Specialist Endocrinologist at The City Hospital in Dubai. "However, a patient with well-controlled diabetes, who doesn't have major complications, or experiences dangerous fluctuations of their blood sugar, can safely fast. If they decide to do so, they should undergo a pre-Ramadan assessment and receive appropriate instructions related to meal planning, glucose monitoring, and dosage and timing of medications. The management plan must be highly individualised and close follow-ups are essential."
Patients at risk
Consulting a doctor before fasting is not limited to diabetics, says Laz. "People with insulin resistance, unstable coronary artery disease, congestive heart disease, chronic kidney disease, chronic liver disease and those on dialysis are at risk while fasting." He adds that the elderly and those with or prone to kidney stones should also avoid fasting.
Diabetes comes in two forms — Type 1 and Type 2. The first is controlled through the use of insulin, the second through diet alone, except in some case where medication is needed. Complex carbohydrates are essential, especially for diabetics, as they provide energy without causing a spike to sugar levels. They also release energy for long periods of time, helping regulate appetite. Such foods have a low glycaemic load. Simple carbohydrates have a high glycaemic load, being broken down quickly and converted into sugars, which enter the bloodstream, causing a sharp rise in blood sugar levels.
Complex carbohydrates include wholegrain cereals, oats, wheat, beans, lentils, barley and sweet potatoes. Stay away from sugary products and overly processed foods. A rule of thumb is to consider the food's colour — if it is white, cut it out. Opt for brown bread and rice, and whole wheat pasta.
While fasting, eat a good quantity of complex carbohydrates, says Kay Vosloo, Nutritionist, Colon Hydrotherapist and Wellness Screening Consultant at Synergy Integrated Medical Centre. How you end your fast is crucial, as following bad habits can be detrimental to your health.
"When breaking the fast it should be the same as having breakfast, therefore, a light easily digestible meal with a low glycaemic load is advised. We have to remember our stomachs are empty from fasting all day so we shouldn't overload them or they'll not be able to mix and churn the food for easy digestion," she says. "Diabetics have to avoid letting their blood sugar rise too high and too quickly, so it's advisable to consume foods with a low glycaemic load. Try a home-made mixed berry smoothie with plain yoghurt and ground unsalted seeds. A light porridge with cinnamon is another great option."
It's a bad habit to drink while eating as this dilutes the digestive enzymes needed to break down food, explains Vosloo. "But in this case we'll be dehydrated, so a glass of water is needed. Drink it and then wait about ten to 15 minutes before eating," she says.
One of the worst habits, not only for diabetics but everyone, is overeating at night, says Vosloo. Because people eat at this time during Ramadan, it's important to choose the right foods and time your meals so you don't lie down shortly after eating.
"At night, our body clock is slowing down so we should refrain from eating big meals for at least two hours before lying down otherwise digestion will be compromised," explains Vosloo. "Portion control is imperative, too. Imagine the stomach as the size of your fist; we don't want to binge and overload it."
Echoing the importance of ending the day's fast with easy-to-digest food is Dr Alfons Grabosch, Manager, Health Support Department, National Health Insurance Company — Daman. "Diabetics can ensure they get sufficient nutrition by eating dates, an excellent source of fibre, carbohydrates, potassium and magnesium. Almonds provide them with fibre and protein, with less fat. Diabetics, and anyone that fasts, must make sure to minimise consumption of caffeinated beverages as these drain the body of valuable mineral salts," says Dr Grabosch.
Ideal iftar menu
So as to better support your body during Ramadan, Dr Grabosch suggests eating four regular meals that are well spaced out. An ideal iftar (the meal eaten by Muslims after sunset in Ramadan) includes low-fat foods such as a green salad or soup, he says. Dinner should be eaten about an hour later and be based on protein, vegetables and complex carbohydrates. After the Taraweeh prayer, have a small amount of sugar-free low-calorie dessert such as cream caramel, jelly, fruit salad or a pudding. suhoor (the meal consumed early in the morning by Muslims before fasting in Ramadan) should be a meal high in fibre but low in fat. Avoid coffee and tea as they have a diuretic effect, he says.
"A heavy meal will interfere with your blood sugar levels and appetite. For suhoor, or before going to bed, it's highly advised to refrain from overeating to avoid a sharp increase in sugar and ensure the stomach does not release a high level of digestive enzymes, which can cause difficulties with controlling the appetite," he says.
ADVISORY: SUGAR DIP - SYMPTOMS AND SOUTIONS
General warning signs that your sugar levels have become unstable include sweating, dizziness, heart palpitations, shivering, sight problems, paleness and an inability to concentrate, says Dr Alfons Grabosch, Manager, Health Support Department, National Health Insurance Company — Daman. "Type-2 diabetics experiencing these symptoms, or any abnormalities for that matter, must check their blood sugar immediately."
If your sugar levels are below 70mg/dl, you must break your fast. Either take a glucose tablet, drink around 180ml of fruit juice, preferably apple juice, or a have a non-diet soft drink. Wait 15 minutes and measure again. If it's still under 70mg/dl, then repeat the previous regimen.
"Insulin-dependent diabetics are very sensitive cases and each one must be examined on an individual basis. I recommend that they consult with their physicians before deciding to fast and agree on measures to take when facing any issues during fasting," says Dr Grabosch.
CASE STUDY: HOW A INSULIN-DEPENDENT DIABETIC MANAGES RAMADAN
"I am a Type-1 diabetic and if I don't eat for a long period of time my blood sugars will eventually get dangerously high," explains Sabah Husain, a British expatriate student in Dubai. "If I don't provide my body with the energy it needs from complex carbohydrates, my body's cells start to crave glucose. My liver then emits a large amount of glucose into my body, which makes my blood sugars go even higher. Eventually, my body will start breaking down fat and muscle tissues for energy. This is when the acid ketones is released into my blood stream. If I still don't eat, the acid builds up and I can suffer from ketoacidosis, which can put me into a coma and kill me."
It's easy to understand why the 20 year old would avoid fasting but that's not the case. Husain often fasts during Ramadan.
"I've had to break my fast before but I usually don't have a problem. You're allowed to break the fast if you need to; you shouldn't put yourself in danger," she says. How does she manage? "I check my blood sugars regularly. I consult my doctor daily and go for check-ups. I follow the eating plan she prescribes."
Complex carbohydrates and exercise are important to managing sugar levels, says Husain. "I do yoga twice weekly, which keeps me feeling fit; I don't exercise often as it's hot and humid, which can make fasting more dangerous. I consume complex carbs; if I don't, my blood sugars would be all over the place. I follow my eating plan and get it right."
