Children with diabetes need special attention in the holy month of Ramadan. While generally exempt from fasting, those wishing to observe this sacred ritual must be carefully monitored, say experts. Dr Amani Taha Osman, Consultant General Pediatric, Imperial College London Diabetes Centre, Al Ain, talks to GN Focus about how children with diabetes can approach long and intense fasts, such as the ones we are seeing this summer.
Is fasting recommended for children/teens with diabetes?
Type 1 diabetics are at high risk of complications when fasting and are therefore exempt from fasting according to Awqaf’s fatwa, based on their doctor’s recommendations. Diabetic children who fast require special attention from paediatricians.
Are there any specific risks to consider for diabetic children?
When fasting, about eight hours after the last meal, the body starts breaking down energy stores to stabilise blood glucose in the normal range. In diabetic children, their glucose homeostasis/balance requires close intervention during fasting as they are at a higher risk of low sugar, high sugar, dehydration, clots and acidosis.
This year the fasting period is long (about 15 hours in the UAE), meaning that the risk of hyperglycemia and dehydration is high. It is important that anyone living with type 1 diabetes understands they are at a higher risk compared to those with type 2 diabetes when fasting and are generally advised to not fast.
If children living with type 1 or type 2 intend to fast, they should be closely supervised by their pediatrician and ensure that their medication and blood sugar is regularly monitored to mitigate health risks. For example, if they are taking certain tablets and/or insulin, fasting carries the risk of both low and high blood glucose levels. In extreme cases both can lead to diabetic ketoacidosis (breakdown of fat leading to the pH in the body becoming acidic), a serious condition often requiring swift hospital treatment for type 1 diabetics. The family needs to be aware of the symptoms such as vomiting, abdominal pain, lethargy and altered breathing.
What foods are suitable for diabetics who are fasting?
Choose low-glycaemic index food that have a steady effect on blood sugar levels. Usually they are high in fibre and are slow-release carbs, which are excellent when ending the fast as the energy is sustained and sugars are more stable, leaving you feeling full for longer. Fill half the plate with non-starchy vegetables, while starchy vegetables and slowly absorbed grains should take up a quarter, and lean meat or protein take up the other quarter. Include dairy in the meal. Fast-release carbs, sugary food and high-glycaemic index food should be avoided.
How often should fasting diabetic children check their insulin during the day?
To keep children safe while fasting their blood sugar levels should be tested if they are taking medication to treat diabetes. Blood glucose testing will not break their fast according to the Awqaf’s fatwa. We still recommend checking their blood sugar before meals, two hours after meals and during the day while fasting and also whenever there are symptoms of low sugar or if they are feeling unwell.