Dubai: UAE doctors have shared how some people with diabetes can fast under proper medical guidance.
Dr Hala Youssef Hamdy, specialist endocrinologist at RAK Hospital, said: “All diabetics who plan to fast during this month must get their health check and observe the fast under the guidance of their endocrinologist.”
He explained:“It is possible for many diabetics to fast depending on their overall HbA1c levels which is easily determined by a simple blood test. HbA1c or glycosylated haemoglobin is an indicator of an individual’s blood-sugar levels for three months. The haemoglobin protein in our red blood cells combines with a molecule of glucose and turns into glycosylated haemoglobin. In non-diabetics, the HbA1c reading is between 5.2 and 5.5, it is about 5.5 and 6 in pre-diabetics and in cases of people with diabetes, the HbA1c reading can be anything beginning from 6 up to 14.”
Why checking HbA1c is important
Dr Ali Al Diabbiat, consultant endocrinologist and diabetologist from Prime Health Care Group explained why HbA1c was so crucial. “The higher the HbA1c level, the poorer the blood-sugar control. So as per the guidelines from the International Diabetic Federation (IDF), those with very severe insulin dependent diabetics are not advised fasting. These are people with HbA1c higher than 8.5. These patients need to have their blood sugar levels checked before every meal and they are usually insulin injection-dependent.”
He added: “Long hours of fasting could result in hypoglycaemia [which is low sugar in blood and can be fatal] or hyperglycaemia [which is high blood sugar level that can also induce diabetic coma]. Only those patients who have good blood sugar control with pills, and have an HbA1c level between 6.5 up to 8.5 can observe the fast under the supervision of their doctor.”
Blood sugar swings
Dr Hamdy explained how lack of adequate insulin affects a diabetic. “Diabetes Mellitus or Type II diabetes mainly concerns glucose metabolism in the body. All the food we eat is broken down into simple glucose in the process of absorption and this glucose is converted in to energy that is utilised by the body through the process of metabolism,” he said.
“In our body, insulin, the hormone made by the endocrine gland, pancreas, plays a key role in glucose metabolism. However, diabetics either suffer with insulin resistance [where insulin is unable to enter the cells to metabolise the glucose], or insulin production in pancreas is impaired [there is underproduction of the hormone]. Due to this, glucose is not metabolised and higher concentration of sugar keeps circulating in the blood causing damage to the organs.
“It also making a person weak because of lack of energy. While intermittent fasting, like what is practiced during Ramadan with the dawn to dusk fast, is very therapeutic and helps the body utilise stored fat and can heal a person, it can also cause severe hypoglycemia in diabetic and damage their organs.”
How diabetics can safely observe fast
Dr Diabbiat added: “People with moderate diabetes who take pills for sugar control can fast, provided they eat judiciously during the main two windows [suhoor and iftar]. They must choose the right level of medication prior to the meal; take dense carbohydrates, with lower Glycaemic Index [GI]. GI is an indicator of the rate of release of sugar from the food in the process of digestion.
Their meals must also include plenty of water and have high fibre. They must also include light physical fitness after they have ended their fast. If they can follow these steps then can easily observe the fast.”
Calorie counting
One of the most crucial aspects of fasting for diabetics is the quality and amount of nutrition they take during suhoor and iftar and this holds the key to keeping blood sugar under control.
Advising many diabetics on their nutritional guidelines for Ramadan, Deepshika Agarwal, nutritionist and health coach and Cocoona Aesthetics, said: “Good nutrition is the key to blood sugar control for all diabetics. Diabetics must ensure that about 30-35 per cent of total calories of the day during suhoor and 40-45 per cent during main iftar meal. The remaining 15 per cent can be ingested through a light snack during the eating window [after ending the fast and before the main iftar meal].”
Right balance
"Diabetics must also ensure that nearly 35-50 per cent of their total food intake during suhoor or iftar must come from nutrition-dense carbohydrates, 30 -35 per cent from protein [mainly plant-based] and only 10-15 per cent from Omega-rich fatty foods. This kind of nutritional break up of food will give a slow release of sugar and ensure good blood sugar control. They must check their blood sugar levels prior to the two main meals to decide on the level of medication and also random blood sugar test must be done in the day to ensure that they do not suffer sudden hypoglycaemia.”
As a thumb rule, diabetics must choose for their suhoor and iftar main meals, meal combinations that are high in fibre and low in GI. Foods that are dense in carbohydrates such as whole foods and high-fiber food are absorbed slowly and do not cause sudden blood sugar spikes. Simple or processed carbohydrates such as chips, white flour, high-sugar drinks can dangerously spike blood sugar levels and must be avoided by diabetics.
If the absorption is slow, the blood sugar does not spike and it keeps you full for a longer time. It also helps one have a steady blood sugar absorption and keep you full for a long time.
For suhoor, Agarwal advised diabetics to choose something like steel rolled oats soaked overnight in a plant-based milk such as coconut or almond with nuts, seeds and fruits. “It is also good to make a lentil-quinoa porridge with nuts and seeds accompanied with a salad with fresh vegetables or an omelette with mushroom and vegetables,” said Agarwal.
She added that these options for suhoor were not only nutritious and filling but could help keep the blood sugar at an optimal level. “However, the dose of medicine during meal time must be tweaked by your doctor based on your HbA1C levels.”
For iftar main meal, Agarwal recommended diabetics to choose a brown rice biryani with lots of vegetables and fish or chicken pieces. If not that, a shakshouka with good amount of eggs, more vegetables and minimum cheese could be a good option too. Other alternatives include a good combination of protein with carbohydrates, such as grilled chicken with Arabic bread, chickpea salad with vegetables, and quinoa or barley pilaf with lot of vegetables in it.
“Add a probiotic Laban, flood seeds, probiotic drinks, that can cool you and enrich your gut microbiome and increase the healthy flora in your digestive system,” recommended Agarwal.
Sharing a word of caution to all diabetics, Agarwal said: “Do not end your fast with artificially added sugar drinks. Always choose to end your fast with a fruit or natural available sugar such as dates, a piece of fruit and coconut water. Caffeinated drinks like soda, tea or coffee have a diuretic effect and trigger dehydration besides spiking blood sugar levels.”
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Tips for fasting diabetics
• Get a complete blood panel test done, including liver and kidney function and average blood glucose level as well as HbA1C levels, to get an idea of your blood sugar control
• Be under the guidance of a qualified endocrinologist and nutritionist
• At suhoor, wake up pre-dawn and check your fasting blood sugar. If it is within the right range (90-120 mgdl) then you can take a good suhoor meal as advised by the nutritionist
• If levels are high, then adjust the dose of your medication as per the guidance of your doctor to make sure the blood glucose does not rapidly rise or fall.
• It is advisable to choose whole grain, high fibre, low glycemic index foods for suhoor such as oats, lentil, quinoa porridge with skim or plant based milk and nuts and flax seeds, or a boiled egg and whole grain bread sandwich with hummus and greens along with a fruit and yoghurt smoothie
• Make sure to get enough rest and hydration throughout the fasting hours and do a random blood glucose test. If blood sugar falls below 80, then it is advisable to end the fast that day instead of going under a hypoglycaemia episode which can cause a lot of harm, advise doctors
• During Iftar, end the fast with natural sugars such as dates and coconut water, followed by light, clear vegetable soup that will help in a slow rise of blood sugar. Remember hydrate yourself well.
• For main iftar meal choose a combination of dense carbohydrate, vegetable and lean meat
• Make sure to have a light exercise schedule, two hours after iftar.
• Try and turn in early, latest by 11pm, to be able to get deep and restful sleep which trigger cellular repair and healing and be therapeutic
