Diabetics must take extra care

Ramadan is days away. Just the thought of that opens up a Pandora's Box of wonderful feelings. The spiritual aspect of it is definitely prominent.

Ramadan is the Islamic month of fasting, in which participating Muslims refrain from eating and drinking during the day — from dusk until sunset. This year in particular, the hours of fasting will be very long ( 14 hours and 50 minutes on the first day.) Moreover, this year, Ramadan also falls in the peak summer month of August.

So while the fast is aimed to foster patience, humility, and spirituality, the long hours of fasting coupled with extreme high temperatures will certainly be taxing on one's body; especially if you are diabetic. Diabetics are prone to sugar fluctuations and can suffer from complications of a sudden drop in blood sugar; therefore, they have to adhere to certain precautions to ensure they do not suffer from any complications of fasting.

Being a physician and, more so, one who deals with diabetes, inevitably brings us face to face with the same critical questions this time of the year: "Doctor, should I be fasting? What should I do with my medications? What happens if my sugar drops too low?"

People with diabetes, just like any other Muslim, want to reap in the rewards of this holy month.

By and large, a considerable number of people with diabetes, mostly those with Type 2 diabetes, should be able to fast. However, there are cases, where it is medically inadvisable to proceed with fasting. Our religion clearly allows us to make these exceptions. In general, every diabetic who fasts, must follow certain steps to stay clear of health complications.

First of all, I strongly recommend that every diabetic should visit their healthcare practitioner with regards to the feasibility of fasting. This individual is generally well aware of the patient's medical history and can make a valid conclusion in terms of the patient's ability to fast.

Next is an adjustment in terms of the medication dosage. Since each patient has a unique treatment plan, this has to be dealt with on an individual basis by their physician. As a general rule, the requirements of medications do tend to go down during this time, but there are always exceptions to the rule. This is followed by recommendations with regards to lifestyle, mainly diet and exercise.

Monitoring blood sugar

Dubai is indeed unique in many ways. The variety of culture and the diversity of culinary delights that are available here are hard to find anywhere else. Every Ramadan, this comes to a full bloom with the availability of an assorted array of food lined up at countless iftar and suhour buffets set up across the city. There is food to cater to every taste and every budget. Any mortal can and does give in to these temptations. People with diabetes are not any different. However, what is different is their ability to handle the fluctuations in blood glucose and fluid levels.

Some tend to binge at iftar time whereas some others tend to eat steadily from iftar to suhour, both leading to different kinds of problems in the diabetic population. A more organised meal plan needs to be pursued, preferably with the help of a trained dietitian. If a dietitian is not available, a balanced meal with emphasis on ‘simple' carbohydrates for iftar and ‘complex' carbohydrates for suhour should be the goal. Bread, cake, pasta made from white flour, and boxed cereals are example of ‘simple' carbohydrates. ‘Complex' carbohydrates are high fibre foods such as beans, potato, and wild rice. Complex carbohydrates are digested more slowly than simple carbohydrates and keep the sugar levels even over a long period of time. Similarly, a healthy exercise regime should also be followed.

Monitoring of blood glucose at home is also very essential. This helps the health care providers make the necessary adjustments to the medication dosage throughout Ramadan.

It is essential that the blood sugar be checked immediately upon the onset of any symptoms of hypoglycemia or low blood glucose levels. If this is the case, the person should immediately ingest carbohydrates (preferably fruit juice) to bring up their blood sugar level. This breaking of the fast is entirely permissible from a religious perspective.

Like I said, in the last few years, the start of Ramadan has slowly moved into the summer. In Dubai, this takes a whole different meaning given the heat and humidity. As people are unable to drink during the daytime hours while fasting, special care should be observed to avoid dehydration. In terms of diabetes, if the blood sugar levels become elevated, the natural response of the body is to try to flush it out. This requires water. Whenever the blood sugar levels rise, even while not fasting, diabetics tend to urinate more frequently to flush the extra sugar out. Then, they replenish their fluid by drinking more water. That is why people with high sugars are constantly thirsty and urinate frequently. While fasting, the ability to replenish the water is not there and this leads to dehydration, which can be extremely dangerous. Therefore, it is imperative that the intake of carbohydrates, as well as fluids, is well regulated during this month.

All of the above may seem quite overwhelming but it all boils down to the following: Check with your doctor before you start to fast; seek help in adjusting your medication; drink plenty of fluids when you can; eat healthy and enjoy the blessings of Ramadan.

With this, I would like to wish all the readers Ramadan Kareem.