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Ramadan is approaching and Muslims all over the world are preparing to fast from dawn till sunset every day for a month. During this time, their normal diet routine is replaced with feasting only twice a day, once before sunrise (Suhoor) and later after sunset (Iftar). Such a change in lifestyle may increase the risk of fluctuations in the blood sugar levels, causing hyperglycemia. If you have diabetes and you’re gearing up to fast during Ramadan, here are a few things you should know.

What’s Hyperglycemia?

It is the technical term for high blood sugar. When the blood glucose is greater than 125 mg/dL while fasting and greater than 180 mg/dL 2 hours postprandial, the condition is known as hyperglycemia.1 The symptoms of hyperglycemia include high blood sugar, high levels of sugar in the urine, frequent urination and increased thirst.2  The risk of severe hyperglycemia during fasting is 3.2 times higher in patients with type 1 diabetes and five times higher in those with type 2 diabetes.3

As a diabetes patient, you are prone to blood glucose changes every day. Managing this condition with a proper diet and medication routine helps keep the levels under control. However, fasting during Ramadan can influence the occurrence and frequency of such events. Summer fasting can further be a difficult scenario because of increased loss of water from the body, which causes dehydration.4

Why the Risk?

Diet Routine

What and when you eat affects your blood sugar level. The changes in quantity, quality and timing of the meals during Ramadan meddles with the sugar levels in the blood. Eating only twice a day, after a gap of 18-20 hours shakes your diabetes care plan.

Moreover, mouth-watering Iftar meals are mostly rich in sugar and carbs that act as an instant dose of energy. However, a lack of diet control at this time can lead to complications such as hyperglycemia and worsen your condition. The sudden intake of calorie-rich food after hours of fasting can potentially raise blood glucose levels.3

Medication Routine

Most people with diabetes modify their medication regimen to suit the needs of the fast. They tend to excessively reduce their diabetes medication due to fear of hypoglycemia during fasting.3 These alterations, when done without medical guidance, lead to fluctuations in blood sugar level. 

What to Do?

When you become aware of the risks associated with fasting, you are in a better state to reduce the complications. Here are a few points you should keep in mind before deciding to fast.

Talk to the Doctor: Discuss with your doctor the risks involved in observing fasts. Ideally, the doctor would recommend you to go through pre-risk assessment tests and advise accordingly.

Collect Information: Post the discussion with your doctor, keep the following points in mind if you choose to fast.5

  1. Be fully informed about ways to manage your condition.
  2. Gather information related to daily activity, diet, glucose monitoring and medication adjustments that you need for that month.
  3. Stay abreast with the signs and symptoms of hyperglycemia.
  4. Regularly monitor your blood glucose levels while fasting, 2-3 times a day is advisable.
  5. If the readings suggest irregularities, consult the doctor immediately or break the fast if possible. You may cover for the loss of days once you’re in a better condition.

Now you know why and how fasting can lead to hyperglycemia in people with diabetes. Consider everything before and after you decide to take up fasting. Keep your doctor in the loop at all times. Happy Ramadan!  


References:

  1.   Mouri MI. Hyperglycemia [Internet]. StatPearls [Internet]. U.S. National Library of Medicine; 2020 [cited 2020Mar9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430900/
  2. Hyperglycemia (High Blood Glucose) [Internet]. Hyperglycemia (High Blood Glucose) | ADA. [cited 2020Mar5]. Available from: https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hyperglycemia
  3. Raveendran AV, Zargar AH. Diabetes control during Ramadan fasting. Cleveland Clinic Journal of Medicine. 2017Jan;84(5):352–6.
  4.   Almalki MH, Alshahrani F. Options for Controlling Type 2 Diabetes during Ramadan. Frontiers in Endocrinology. 2016;7.
  5. Beshyah S. IDF-DAR practical guidelines for management of diabetes during ramadan. Ibnosina Journal of Medicine and Biomedical Sciences. 2016;8(3):58.

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Disclaimer: The information provided in this article is for patient awareness only. This has been written by qualified experts and scientifically validated by them. Wellthy or it’s partners/subsidiaries shall not be responsible for the content provided by these experts. This article is not a replacement for a doctor’s advice. Please always check with your doctor before trying anything suggested on this article/website.

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