Decreased food intake during the month of Ramadan is a well-known risk factor for the development of hypoglycemia among individuals with diabetes who choose to fast. Abstention from food and fluids for approximately fifteen hours a day can cause a sharp drop in blood glucose levels whereby patients do not have enough energy to perform their normal daily activities, Dr. Mahmoud Ali Zirie, Senior Consultant and Head of HMC’s Endocrinology and Diabetes Division, explained.
Generally, diabetes is divided into two forms; Type 1 and Type 2. Patients with Type 1 (mainly diagnosed in childhood) are dependent on insulin and more prone to sudden hypoglycemia so they are advised not to fast. Patients with Type 2 (mainly adults) are generally not insulin dependent.
Hypoglycemia generally occurs when a diabetic patient significantly alters their dosage of oral hypoglycemic agents or insulin, misses a meal (for example, the pre-dawn meal during fasting), or performs excessive physical activity, Dr. Zirie informed.
Initial symptoms of hypoglycemia include trembling, increased hunger, perspiration, a quickened heartbeat, lack of concentration, irritability and confusion. These symptoms must be addressed immediately. If left untreated, they may develop into more serious symptoms such as convulsions and loss of consciousness. When the Initial symptoms of hypoglycemia appear, patients should check their blood glucose level and break their fast. Unconscious patients should not be given any beverages, to avoid the risk of chocking. Urgent medical care should be sought.
Hypoglycemia is more dangerous than hyperglycemia; as patients with hypoglycemia are susceptible to losing consciousness. Dr. Zirie stresses that this is particularly concerning in instances where the individual may be driving or be in an elevated place.
Before making the decision to fast, patients are advised to seek advice from their healthcare provider on a treatment plan, medication dosages and diet. Diabetics should also get into the habit of carrying sugar pills or packages of sweetened juice, which should be consumed at the presentation of such symptoms.
Fasting diabetic patients should also limit their intake of dates to one or two per day, just enough to raise their blood sugar before Iftar (sunset meal). They should consume whole bread and long-lasting proteins, such as cheese and eggs, at Suhoor (pre-dawn meal). It is advisable to have a snack, preferably fruit, between the two meals and to do light exercise, such as walking, afterwards. Individuals with diabetes who fast should also take care to consume sufficient amounts of fluids, such as water, soup and sugar-free juices, to avoid dehydration.
In recent years HMC has continued to improve the provision of care for people with diabetes in Qatar. National Diabetes Centers have been opened at both Hamad General and Al Wakra Hospitals and provide a range of services from initial screening through to treatment, health education and the provision of medication and equipment.
During the month of Ramadan HMC is also supporting a phone-based emergency service, which allows any patient with diabetes, their relatives or caregivers, to call and ask for medical advice related to diabetes and fasting. The hotline (5598.1331) is operational from 8pm to 11pm, seven days a week.
Tips and information about living well with diabetes during Ramadan, and throughout the rest of the year, are also available at diabetes.hamad.qa