Ramadan, fasting, and diabetes: everything you need to know!

The holy month is upon us - big family gatherings, lots of cheer, fasting, and of course the desserts! The spirit is palpable in the air and new (and many times temporary) habits get formed overnight. However, before you decide to start fasting, it is imperative that you check in with your doctor to see if you are cleared medically to fast, and if you are allowed to, how you are currently managing your diabetes. It is also important to have a recent set of blood tests and to discuss any diabetes medications you are taking and any existing diabetes complications and your management protocols.

Planning is Key!

When discussing the option to fast with your doctor, it is important to discuss the following points so you can fast safely.  

• Increase your blood sugar monitoring during fasting time

• Plan of action should your blood sugar be too low or too high

• What to do if you are not feeling well 

• Adjust your diabetes tablets: you may need a different dose and need to know the best time to take them based on your new fasting schedule.  

• Adjust your insulin: the type of insulin may change from the one you’re used to taking. Remember, pre-mixed insulin is not recommended during fasting.
  

Blood Sugar Levels and Triage

Fasting while taking diabetes medication or insulin carries a risk of low blood sugar levels and can trigger a hypoglycaemic attack. If your blood sugar is low you must break your fast and treat the episode with some sugary food or fluid and follow this with something starchy. If you don’t treat the hypo attack swiftly by breaking your fast you may do harm to your body and might need medical attention. Always carry a sugary snack with you and a bottle of water during the fasting period as your emergency kit. 

At the other end of the spectrum, you may develop high blood sugar levels while fasting because you are missing your usual medication or if you are being less physically active. High blood sugars can increase your risk of dehydration which can make you feel dizzy and tired.  This could lead to a condition called diabetic ketoacidosis which is a serious condition requiring hospitalization.

Healthier food and drink choices during Ramadan 

At Sohour

It is very important that you do not skip your Sohour meal. Lentils, chickpeas, eggs  and beans are good sources of protein and are also high in fiber. Paired with fruit and vegetables, this can help prevent constipation and keep your heart healthy.  

At Iftar Meal (breaking of fast) 

Many people like to break their fast with dates and milk. If you like to break your fast with dates, try to limit the number to one to avoid a spike to your blood sugar levels - of course just a glass of water would be ideal.

Hydrate, hydrate, hydrate! Try to consume sugar free drinks – water is always the best option. Avoid sugary fizzy drinks or fruit juices as these will raise your blood sugar and could make you feel thirstier when fasting the next day.  

Milk drinks are a good source of protein and calcium, but unsweetened versions are the healthier option, especially for people with diabetes.  

It is always tempting to snack on sweet treats - especially if family or friends are sharing them. Treats such as basboosa, baklava, and other Ramadan favorites can be high in fat and sugar. Only a small amount can make quite an impact on pushing up your blood sugars so try to reduce, or ideally eliminate, their consumption.   

Try to limit fried and oily foods as eating them too frequently could lead to unintentional weight gain throughout Ramadan. These foods can also affect your heart health as they tend to be higher in certain saturated fats and salt which could increase your blood cholesterol and blood pressure above healthy levels.  

Carbohydrates that are good to have

All carbohydrates affect blood glucose levels so it’s important to know which foods contain them. It is important to cut down on foods low in fiber such as white bread and white rice. Choose the healthier food options that contain good carbs and be aware of your portion sizes. Some ideas of foods with healthy sources of carbs include:

• whole grains like brown rice

• fruits

• vegetables

• legumes such as chickpeas, beans and lentils

• dairy like unsweetened yogurt and milk

Consume less salt

Salt can elevate your blood pressure, which in turn increases your risk of heart disease and stroke - especially if you have diabetes.

Limit yourself to a maximum of 6g (one teaspoonful) of salt per day. Readymade meals, fast food, and processed foods contain a large amount of salt. You can swap out salt for different types of herbs and spices to add that extra flavor.

Eat less red and processed meat

If you’re cutting down on carbs, you might start to have bigger portions of meat to fill you up. But it’s not a good idea to do this with red and processed meat, sausages, beef and lamb. These all have links with heart problems and cancers. Try swapping red and processed meat for these:

• Legumes such as beans and lentils

• Eggs

• Fish

• Chicken

• Turkey 

• Unsalted nuts.

Beans, peas and lentils are also very high in fiber and don’t affect your blood glucose levels too much – making them a great swap for processed and red meat and keeping you feeling full for longer. Try to eat two portions of oily fish per week.

Eat more fruits and vegetables

It’s always a good thing to aim to eat more fruits and vegetables at mealtimes, as well as having them as snacks if you’re hungry. This can help you get the vitamins, minerals and fiber your body needs every day to help keep you healthy.

Whole fruit is good for everyone and if you have diabetes, it’s no different. Fruits do contain sugar, but it’s natural sugar. This is different to the added sugar (also known as free sugars) that are in things like chocolate, biscuits and cakes. Fruit juices have added sugar so try to avoid those. It’s also best to eat fruits throughout the day instead of one larger portion.

Choose healthier fats

We all need fat in our diet because it gives us energy. But different types of fat affect our health in different ways. Healthier fats are in foods like unsalted nuts, seeds, avocados, oily fish, olive oil, rapeseed oil and sunflower oil. Some saturated fats can increase the amount of cholesterol in your blood, increasing your risk of heart problems. These are mainly found in animal products and prepared foods such as:

• Red and processed meat

• Ghee

• Butter

• Lard

• Biscuits, cakes, pies and pastries.

It’s still a good idea to cut down on using oils in general, so try to grill, steam or bake foods instead.

Cut down on added sugar

We know cutting out sugar can be really hard at the beginning, so small practical swaps are a good starting point when you’re trying to cut down on excess sugar. Swapping sugary drinks, energy drinks and fruit juices with water, plain milk, or tea and coffee without sugar can be a good start. Cutting out these added sugars can help you manage your blood glucose levels, which in turn helps you manage your weight. You can always try low or zero-calorie sweeteners (also known as artificial or non-sugar sweeteners) to help you cut back. These can also be helpful for weight loss in the short term if you don’t swap for other foods and drinks containing lots of calories. But, in the long term, try to reduce the overall sweetness in your diet.

Be smart with snacks

If you want a snack, choose yogurts, unsalted nuts, seeds, fruits and vegetables instead of crisps, chips, biscuits and chocolates. But watch your portions still – it’ll help you keep an eye on your weight.

Fasting can be done, even if you are diabetic. The key to a successful and healthy fast is to check in with your doctors to ensure that you are ok to fast, make any necessary adjustments to your medications, and try to eat as healthy as possible to avoid spikes in your glucose levels when you break your fast. And as with everything, LISTEN TO YOUR BODY! If you are not feeling well, stop fasting and consult your doctor to ensure that all your levels are in the acceptable range and that you do not require any additional medical care.