Caution advised for diabetics

Type 1 diabetes patients who are unwilling or unable to monitor their blood glucose levels multiple times daily are at high risk and should be advised not to fast during Ramadan. However, Type 1 diabetics do have the option of fasting if and when they manage to adjust their insulin dosage between the post-sunset meal ‘iftar' and pre-dawn meal ‘suhour'. Dr Ala'a Al Din Mahmoud, Consultant Endocrinologist at NMC Speciality Hospital, advises Type 1 diabetic patients to take an insulin injection known as the "peakless long-acting insulin" (which lasts up to 24 hours), and is taken at a fixed time once a day. This helps control the person's blood glucose level. Normal days Article continues below A long lasting insulin dosage however must be reduced during Ramadan by around 70 to 80 per cent, added Dr Ala'a. Another injection, known as the "ultra-short acting insulin injection" (which lasts between two to three hours) is also recommended during Ramadan, depending on a person's meal intake. "The advantage of ultra-short acting insulin is that it can be taken any time the patient eats. If and when a Type 1 diabetic eats a bit too much, he can increase the insulin dose. Insulin does not break a person's fasting," said Dr Ala'a. Type 2 diabetics are advised to take their medication alongside their main meal, which for many people is usually iftar. "Medication doses depend on when the person decides to have his/her main meal, and that can be anytime between iftar and suhour. However, a medicine's dosage needs to be halved if taken during suhour, since we worry the person's blood sugar level will drop the next day," he said. When asked about physical activity in Ramadan, Dr Ala'a said: "Excessive physical activity may lead to higher risk of hypoglycemia [low blood sugar] and should be avoided, especially before the sunset meal. If the Taraweeh prayer (multiple prayers after the sunset meal) is performed, then it should be considered a part of the daily exercise programme." Diet during Ramadan should not differ significantly from a healthy and balanced diet. It should aim at maintaining a constant body mass. The common practice of ingesting large amounts of foods rich in carbohydrate and fat, especially at the sunset meal, should be avoided. Dr Maha Taysir Barakat, medical and research director and consultant endocrinologist at the Imperial College London Diabetes Centre (ICLDC) said: "Try not to be tempted to eat continuously from iftar to just before Fajr. At Iftar, try ending your fast with a light snack such as dates and soup. "Then have a full meal about an hour later, followed by breakfast meal just before fajr. It's important to stay hydrated by drinking enough water. Avoid drinks containing sugar as dehydration occurs from not drinking water during the day and then breaking fast on sugary food or drinks. The result could be a state of high blood glucose levels that may require hospital treatment."