Ramadan = two-thirds of the medication is taken with breakfast and suhoor

Twice a Day with Food in Ramadan

Ramadan holds great significance for Muslims around the world, especially regarding fasting, which is one of the Five Pillars of Islam.

This article examines the medical challenges faced by individuals with diabetes who choose to fast during this holy month, along with the necessary medical recommendations and guidelines to help them fast safely.

This applies to most medications, including blood pressure, diabetes, cholesterol, anticoagulant medications, chronic disease medications such as methotrexate, cancer medications, and others.

The impact of fasting on blood sugar and fat levels, as well as potential acute complications such as hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), dehydration, and blood clots, is discussed.

The importance of medical evaluation and education before Ramadan is emphasized, along with adjustments to treatment plans and medications to align with the timing of Iftar (meal to break the fast) and Suhoor (pre-dawn meal).

Prevalence of Diabetes Among Fasting Muslims:

It is estimated that about 50 million Muslims worldwide suffer from diabetes, many of whom choose to fast during Ramadan despite the religious exemption for the sick.

Managing diabetes while fasting involves careful planning, such as adjusting medications, and taking special precautions to monitor health during the fasting hours.

Adjusting Medication During Ramadan:

For those who take medication once a day, the dosage may be halved or taken on alternate days.

For those who take medication twice a day, it should be administered once.

If a person takes medication three times a day, it should be adjusted to twice daily—during Iftar and Suhoor.

Patients should also monitor for any signs of health complications, returning to their regular dose if needed.

Risks of Fasting for Diabetic Patients:

Fasting presents several risks for diabetic patients, including hypoglycemia, postprandial hyperglycemia (high blood sugar after meals), and complications related to dehydration and metabolic disturbances.

Impact of Fasting on Blood Sugar and Fat Levels:

Studies show mixed results on how fasting affects blood sugar control.

Some studies have shown slight improvement or no change, while others have indicated an increased risk of hypoglycemia or hyperglycemia.

In terms of fat levels, there is generally little to no change or a slight decrease in cholesterol and triglycerides, with a tendency for an increase in HDL (good cholesterol).

Importance of Medical Evaluation and Education Before Ramadan:

Diabetic patients who wish to fast should undergo a thorough medical evaluation and receive necessary education at least one to two months before Ramadan.

This includes assessing potential risks, modifying meal plans, and adjusting medication schedules accordingly.

Adjusting Diabetes Medications During Ramadan:

Patients with diabetes need to adjust their medication timing to match the Iftar and Suhoor schedule.

Some long-acting medications, such as sulfonylureas, should be avoided, while other medications like DPP-4 inhibitors may require minor or no adjustments.

Insulin can be used with appropriate adjustments to doses and timing, under medical supervision.

General Guidelines for Safe Fasting:

Guidelines for diabetic patients during Ramadan include regularly monitoring blood sugar levels, consuming healthy and balanced meals during Iftar and Suhoor,

drinking enough fluids at night, avoiding excessive physical activity especially before Iftar, and breaking the fast immediately if severe complications such as hypoglycemia occur.

Impact of Social and Religious Practices:

Patients may insist on fasting despite medical advice due to social and religious factors or may not discuss their intention to fast with healthcare providers.

Adjusting medications for other health conditions, such as oral anticoagulants (OAC), is common among fasting individuals, particularly those who take medications twice a day, which can increase the risk of hospitalization.

Medication Adjustments – "Two-Thirds Dosage Twice a Day with Food":

This concept refers to taking the medication twice a day, aligned with Suhoor and Iftar meals.

This might imply reducing the frequency from three times a day to twice, but the total dosage should only be adjusted under a doctor’s guidance.

Conclusion:

Fasting during Ramadan is a significant challenge for diabetic patients, but it is possible with careful planning, education, and consistent medical follow-up.

Patients should consult their doctors before Ramadan to evaluate risks and adjust treatment plans and medications.

Understanding the social and religious practices of Muslim patients also plays an essential role in providing proper healthcare during Ramadan.

FAQs About Fasting and Diabetes During Ramadan:

What is Ramadan and what is the nature of fasting during this time?

Ramadan is the ninth month in the Islamic lunar calendar, during which healthy adult Muslims fast from dawn until sunset. Fasting includes abstaining from food, drink, medicine, and smoking from dawn until sunset, with no restrictions on eating or drinking between sunset and dawn.

What considerations should diabetic patients have when fasting during Ramadan?

Diabetic patients are exempt from fasting if their health is compromised or if fasting could negatively impact their health. However, many diabetic patients choose to fast,

requiring them to take necessary measures for safe fasting, such as medical evaluation before Ramadan, education on meal planning and medication adjustments, and frequent blood sugar monitoring.

What are the potential health risks for diabetic patients fasting during Ramadan?

Potential risks include hypoglycemia due to fasting and medication, hyperglycemia from dietary and medication changes, dehydration from inadequate fluid intake, and an increased risk of blood clots due to dehydration and higher clotting factors in diabetics.

What are the dietary recommendations for diabetic patients during Ramadan?

Diabetic patients should consume healthy, balanced meals at Iftar, avoiding overeating, especially at Iftar.

It is recommended to delay the Suhoor meal as much as possible, ensuring it includes complex carbohydrates for slow digestion. Fluid intake should be increased during the nighttime.

How should diabetic medications be adjusted during Ramadan?

Medication adjustments should be made on an individual basis under medical supervision.

For insulin users, adjustments to both long-acting and short-acting insulin doses may be necessary.

For oral medications, timing adjustments or switching to alternative medications may be required to reduce the risk of hypoglycemia. Long-acting sulfonylureas should be avoided.

Why is medical education before Ramadan important for diabetic patients?

Medical evaluation and education before Ramadan are critical for diabetic patients who wish to fast.

Education should cover fasting risks, meal planning, medication adjustments, blood sugar monitoring, and recognizing symptoms of hypoglycemia or hyperglycemia, as well as when to break the fast.

Does using insulin or performing skin pricks to monitor blood sugar invalidate fasting?

No, using insulin injections and blood glucose monitoring through skin pricks are allowed during fasting because they do not provide nutritional value.

What challenges do diabetic Muslim patients face in majority-Muslim versus minority-Muslim countries

regarding fasting and diabetes management?

In majority-Muslim countries, patients may feel strong social pressure to fast even if their doctors advise against it.

They may not consult healthcare providers before Ramadan or may self-adjust their medications.

In minority-Muslim countries, patients may not discuss their fasting intentions with healthcare providers or seek advice on managing diabetes during Ramadan,

leading to inadequate education and support. Some patients may rely on religious leaders or fellow patients rather than medical professionals for guidance.