Ramadan fasting not only alters the timings of meals but it may also disturb sleep patterns and circadian rhythms, all of which can affect a person’s metabolic state. It thus affects the glycemic status in a diabetic; which needs to be taken into account while fasting for the holy month of Ramadan.
Self – Monitoring of Blood Glucose
- It is very important to monitor blood glucose levels during fasting.
- Need to monitor more frequently if you are on-
- Drugs like sulphonylureas.
- Important to measure blood glucose levels after iftar to detect rise in sugar after eating (postprandial hyperglycemia)
- Check blood glucose levels whenever you experience symptoms of hypoglycemia, hyperglycemia or feel unwell, and need to understand when you should immediately break the fast.
- Avoid rigorous exercises during fasting as it would increase the risk of hypoglycemia and/or dehydration
- Regular light-to-moderate exercises can be done.
Medication adjustments during fasting
- As there occurs a change in lifestyle and eating patterns during Ramadan, there is increased risk of hypoglycemia (low sugars) during the daytime and hyperglycemia(high sugars) at night
- You must see your doctor as part of pre-Ramadan assessment as an adjustment in dosages and timing of medication may be required to minimize the risk of hypoglycemia during fasting.
Fluids and Dietary Advice
|Divide daily calories between suhoor and iftar, plus 1–2 snacks if necessary|
|Ensure meals are well balanced –
|Include low glycemic index, high fibre foods that release energy slowly before and after fasting
|Include plenty of fruit, vegetables, and salads|
|Minimize foods that are high in saturated fats
|Avoid sugary desserts|
|Use small amounts of oil when cooking
|Keep hydrated between sunset and sunrise by drinking water or other non-sweetened beverages|
|Avoid caffeinated and sweetened drinks|
When to break the fast
All patients should break their fast if:
- Blood glucose <70 mg/dL (3.9 mmol/L)
- Re-check within 1 h if blood glucose 7090 mg/dL (3.95.0 mmol/L)
- Blood glucose >300 mg/dL (16.6 mmol/L)
- Symptoms of hypoglycemia, hyperglycemia, dehydration or acute illness occur
When to suspect you have Hypoglycemia (Low Sugars) Suspect it if you have any of the following:
- Altered mental status
When to suspect you have Hyperglycemia (High Sugars)
- Extreme thirst
- Frequent urination
- Fatigue v Confusion
- Abdominal pain
Risk avoidance during Ramadan
- Avoid Hypoglycemia, especially during the late period of fasting before iftar
- Severe hyperglycemia after each of the main meals
- Dehydration, due to prolonged fasting hours and hot climates
- Significant weight gain due to increased caloric intake and reduced physical activity
- Electrolyte imbalance
- Acute renal failure in patients prone to severe dehydration, particularly elderly patients and those with impaired kidney function.
Avoid Unhealthy nutrition habits that commonly develop during Ramadan like:
- Eating particularly large meals at Iftar (frequently containing more than 1500 calories), which may result in severe postprandial hyperglycemia and weight gain
- Eating significant amounts of highly processed carbohydrates and sugar at iftar, or between iftar and suhoor, which may also cause severe hyperglycemia
- Eating desserts loaded with sugar after iftar, which can lead to a prolonged period of postprandial hyperglycemia
- Having large and frequent snacks between the two main meals, which can contribute to longer periods of hyperglycemia
- Eating at a fast speed, which frequently leads to over-eating (satiety signals usually take around 30 minutes to reach the brain from the start of eating)
- Eating suhoor early, which may result in hypoglycemia before iftar, especially when fasting hours are longer than usual
- Consumption of large portions of high glycemic index (GI) carbohydrates at suhoor, which can lead to postprandial hyperglycemia
- Frying food, which is particularly unhealthy, especially when using trans-fat margarine or oils rich in saturated fat (e.g. palm oil and coconut oil)
- Changes in physical activity and sleeping patterns can affect metabolism and may contribute to weight gain.
Basic principles that need to be followed while planning meal during Ramadan:
- Consume an adequate amount of total daily calories and divide them between suhoor, iftar and if necessary, 1–2 snacks
- Use the “Ramadan plate” method for designing meals
- Meals should be balanced, with carbohydrates (low GI preferred) comprising around 45–50%; protein (legumes, fish, poultry or lean meat) comprising 20–30%; and fat (mono and polyunsaturated fat preferred) comprising <35% of the meal.
- Saturated fat should be limited to <10% of the total daily caloric intake
- Sugar-heavy desserts should be avoided after iftar and between meals. A moderate amount of healthy dessert is permitted, for example, a piece of fruit
- Select carbohydrates with low GI, particularly those high in fibre (preferably whole grains). Consumption of carbohydrates from vegetables (cooked and raw), whole fruits, yogurt and dairy products is encouraged. Consumption of carbohydrates from sugar and highly processed grains (wheat flour and starches like corn, white rice, and potato) should be avoided or significantly minimized
- Maintaining adequate hydration by drinking enough water and non-sweetened beverages at or between the two main meals is important and should be encouraged (diet beverages may be consumed). Sugary drinks, canned juices or fresh juices with added sugar should be avoided
- Consumption of caffeinated drinks (coffee, tea as well as cola drinks) should be minimized as they are diuretics v Take suhoor as late as possible, especially when fasting for >10 hours
- Consume an adequate amount of protein and fat at suhoor as foods with higher levels of these micronutrients and lower levels of carbohydrate have a lower GI than carbohydrate-rich foods and do not have an immediate effect on postprandial blood glucose. Protein and fat also induce satiety better than carbohydrates
- Iftar should begin with plenty of water to overcome dehydration from fasting, and 1–2 dried or fresh dates to raise blood glucose levels
- If needed, a snack of one piece of fruit, a handful of nuts or vegetables may be consumed between meals. Generally, each snack should be 100–200 calories, but this may be higher depending on the individual’s caloric requirement. Some individuals may use a snack to break fasting and then eat iftar later in the evening.
|Carbohydrates||Percentage||45-50% of total calorie intake, 130g/d|
|Recommended||Select foods with low Glycemic Index and Load like whole grains. Fiber Intake-20-35g/d Fibre from unprocessed food, such as vegetables, fruits, seeds, nuts and legumes is preferable|
|Not Recommended||Sugar, refined carbohydrates, processed grains and starchy foods should only be consumed in limited quantities, especially sugary beverages, traditional sugar-heavy desserts, white rice, white bread, low fibre cereals and white potatoes|
|Fat||Percentage||Should be less than 35% of the total daily caloric intake. There is general agreement that the type of fat consumed influences cardiovascular disease risk|
|Recommended||PUFA and MUFA (e.g. olive oil, vegetable oil or blended oil [PUFA and palm oil]) are recommended. Oily fish (e.g. tuna, sardines, salmon) are recommended as a source of omega-3 fatty acids|
|Not Recommended||Foods high in saturated fat, including red and processed meats (beef, lamb, hot dog, salami, luncheon meat), and ghee, and foods high in trans-fats (fast food, cookies, margarine and butter made of partially hydrogenated oil) are not recommended|
|Protein||Percentage||20–30% of total caloric intake. Protein is important as it enhances satiety. Protein also helps to maintain lean body mass|
|Recommended||Fish, skinless poultry, dairy, nuts, seeds, and legumes are recommended|
|Not Recommended||Protein sources that are high in saturated fats (e.g. beef, lamb) should not be consumed in excess, as this increases the risk of cardiovascular disease|
Reference – Diabetes and Ramadan: Practical Guidelines; International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance; April 2016