JEDDAH — If you have diabetes, fasting changes your daily routine, including the meal and medication times in addition to the increased consumption of special traditional food that may contain more carbohydrates. If you intend to fast, discuss your management plan with your doctor, diabetic educator OR dietitian; plans are individualized and differ for each specific individual. It is very important to realize that diabetes management during Ramadan depends to a great degree on your compliance with your management plan. Medical assessment before Ramadan is a must. If you have diabetes you must see your doctor for a health assessment one month before Ramadan. In the assessment, your overall well-being and the status of your blood glucose levels, blood pressure, and lipids should be assessed. Based on the assessment, your doctor will advise if you can fast and what medication and diet plan changes are necessary. You must also see your dietitian to discuss changes in your meal plan. You should not fast if you have poorly controlled type I or type 2 diabetes (e.g. if you have a history of ketoacidosis; frequent low or high blood glucose; or severe low or high blood glucose emergencies within the last 3 months; are pregnant; have to perform intensive work outdoors; have low blood glucose unawareness. In this condition, your blood glucose levels suddenly drop even if you are following your medication and meal plan. You are at risk for low blood glucose unawareness if you are on medications that affect your consciousness or are elderly with any degree of alertness problem. Other complications include like heart disease or kidney failure on dialysis, uncontrolled hypertension, severe infection; however, you can fast after recovery. Follow a balanced meal plan during Ramadan. The general diet guidelines are the same during Ramadan. You should still try to eat three meals–Iftar, mid-time meal or a snack, and Suhoor. Use one or a combination of the meal planning tools to help you control your diet during Ramadan, such as “My Plate” method that includes: a cup of low fat or non-fat milk or laban or yogurt; a portion of whole grains or one medium baked potato or half a cup of pasta; a portion of lean meat or skinless poultry of baked/grilled fish; a portion of fresh fruits, such as an orange or an apple or three pieces of dates; a portion of vegetables, such as a cup of green salad or half a cup of cooked vegetables. “Carbohydrate counting” method includes counting carbohydrates in grams or in portions in each meal and snack, where the carbohydrates are found in grains and cereals, fresh or dried fruits, vegetables and milk. In Ramadan specifically avoid eating large amounts of foods rich in carbohydrates and fat, especially at Iftar (the sunset meal), such as fried Samboosa or a lot of dates or greasy rice or sweets. Eat complex carbohydrates at Suhoor (predawn meal), such as whole wheat bread or baked potato or low fat milk or laban or yogurt or cooked lentils or beans or fresh or dried fruits and vegetables. They take more time to digest and absorb; they will help you to feel full and prevent a sudden drop in the blood glucose levels. Simple carbohydrates are more appropriate at Iftar (the sunset meal) to elevate your blood glucose level rapidly, which is usually low at Iftar time. These include sweets or fruit juices, but they should be consumed in moderation. Drink plenty of fluids between Iftar and Suhoor to avoid dehydration, which can lead to low blood glucose. Increase your intake of water between Iftar and Suhoor meals and limit drinking caffeinated drinks because they can cause loss of fluids, leading to dehydration. Avoid excessive consumption of salt, salted or heavily spiced foods. Eat Suhoor meal as close as possible to the start of the daily fast (prior to predawn time). Generally, you can maintain the same normal level of physical activity as before Ramadan. The following tips are important to help you prevent any complications: exercise after breaking the fast and not while fasting. Be aware of low blood glucose signs and always carry sugar-containing food with you while exercising and carry you “Diabetic Identification Card” with you. Excessive physical activity may lead to low blood glucose and therefore, it should be avoided, particularly during the few hours before the sunset meal. If you perform Taraweeh prayer (multiple prayers after the sunset meal), consider it a part of your daily exercise program. If you have poorly controlled type 1 diabetes, exercise may lead to extreme low blood glucose, so you must check with your treating doctor before doing any exercise. Immediately break your fast if you have any of the following conditions: low blood glucose; because your blood glucose levels might get lower if you delay the treatment. If your blood glucose reaches 70 mg/dl in the first few hours of the fasting time, especially if you are taking insulin, or oral diabetes medications at the predawn time. If your blood glucose exceeds 300 mg/dl. Frequent monitoring of blood glucose levels It is important to monitor your blood glucose levels many times daily. This is especially critical for those who have type 1 diabetes, and for those who have type 2 diabetes and take insulin. For more information on diabetes and care, visit the Saudi Diabetes and Endocrine Association's website at [email protected] — SG
