Ramadan and diabetes: As-Saum (The fasting)

Abstract

Ramadan, the ninth month of Islamic lunar calendar, is marked by religious ritual of fasting from early dawn till sunset by Muslims. Islam has allowed many categories of people to be exempt totally or temporarily from fasting. Patients with uncontrolled diabetes face possible major metabolic risks including hypoglycemia, hyperglycemia with or without the risk of impending ketosis, dehydration, and thrombosis. Diabetics can be stratified into four categories based on their level of risk associated with fasting. The recommended ruling for persons in categories 1 and 2 is that they are prohibited from fasting to prevent harming themselves based on the certainty or the preponderance of probability that harm will occur, whereas the recommended ruling for those in categories 3 and 4 is that they should fast. The strategies to ensure safety of diabetics who are planning to fast include Ramadan-focused patient education, pre-Ramadan medical assessment, following a healthy diet and physical activity pattern, physician-recommended modifications in medication protocol and therapeutic recommendations and checking blood glucose as and when required.

Recommendations for management of diabetes during Ramadan: update 2015

“…In addition, patients should be counseled about breaking the fast in the presence of hypoglycemia. 35 …”

Pragmatic dietary advice for diabetes during Navratris

“…Prolonged fasting may deplete glycogen stores, increasing the production and oxidation of fatty acids from adipocytes leading to ketoacidosis. [810] Contraction of the intravascular space and dehydration may increase the tendency of thrombosis during fasting. [510] The quality and quantity of food consumption and changes in weight during fasting days can impact serum lipids levels also.…”

Fasting practices in Tamil Nadu and their importance for patients with diabetes

“…At this point, we have only been able to extrapolate recommendations for South Indian fasting and feasting experiences based on the evidence collated from other communities. [1] Well-designed studies are required to examine ethnic variations in the response to fasting, the effect of medications, and the short- and long-term benefits and risks of fasting and feasting in this population.…”

“…The impact of these fasts on diabetes and its management strategies have been discussed elsewhere. [12] Tamil Nadu celebrates a large number of the festivals that the country celebrates with a regional flavor and food. It also has festivals and observances that are unique to this region.…”