Ramadan is the ninth lunar month of the Islamic year and fasting during the month is one of the five pillars of Islam. It is obligatory for all healthy adults of the Islamic faith to fast between the hours of dawn and sunset. In Holy Quran Sura 2: verse 185 said that; The month of Ramadan is the month when the Quran was sent down as guidance for mankind with clear proofs of guidance and the criterion by which to distinguish right from wrong.
Therefore, whoever of you is present in that month, let him fast; but he who is ill or on a journey shall fast a similar number of days later on. God desires you to fast the whole month, so that you may glorify Him for His having guided you and so that you may be grateful.
As well as the change in dietary pattern there may be a change in content, with increased intake of fat and carbohydrates. These changes in dietary habits present serious problems for patients with diabetics. Normally this won’t happen for normal meal break fast with starting from three dates and light break fast. People forget that they are fasting after break fast and eat like nothing, end up even obesity.
Scientific finding revealed that in people who are well normal homoeostatic mechanisms seem to cope; urinary volume, pH and nitrogen excretion remain within physiological limits. But some studies have reported substantial weight loss and increased plasma concentration of urea and uric acid consistent with catabolism of body mass, but these findings have not been confirmed.
moreWhat issues you should cover - before fasting
* Explore the motivation of fasting - whether he wants to fast (as most will) or whether he is looking for a ‘legitimate’ exemption from fasting on medical grounds. In this point Quran stated in Sura 2;Verse 184; For those who can fast only with extreme difficulty, there is a way to compensate - the feeding of a needy person. But he who does good of his own accord shall be well reward.
This Quran verse says only who are sick, and pregnant women, are allowed to break fast.
* Although everyone agrees on the need to avoid food and drink during daylight hours, a range of views exists on the use of drugs. Ask his opinion on the use of and injectable drugs when fasting. This is allowed unless vaccination is not to fill your hungry.
* Find out how long the fast will last. The length of the fast varies according to the time of year in which Ramadan falls. Ramadan starts on about August 1 this year and in the Sri Lanka the fast will be about 13-14. If Ramadan falls in United Kingdom in this summer, fasts can last for more than 18 hours, in which case fasting for people with diabetes can prove more challenging.
* Inquire about his current treatment regimen, glycaemic control and comorbidities. Achieving good glycaemic control before Ramadan will make it easier to maintain control while fasting. People taking drugs may need to change their regimens.
I would like to recommend patients must get the advice from the physician on this regard.
* If he has some experience of fasting with diabetes, find out how he fared and if he has any specific concerns.
In managing type I diabetics during Ramadan, health practitioners need to be able to advice patients how best to fulfill religious obligations without endangering their health. The result of recent study stated that Type I diabetics may be achieved by use of twice daily administration or rapid acting insuling lispro in combination with and intermediate-acting insulin. Type II diabetic patients have no direct effect on deteriorating the health and advised to fast in the month of Ramadan.
What you should do - while fasting
* Explain that the decision is ultimately his, but that you can advise him and help him maximise his chances of fasting safely. Most people with well controlled diabetes should be able to fast, but if fasting is judged unsafe (in those with brittle diabetes or cardiac or renal complications (or a combination)), clearly communicate this. Most people will be receptive to such advice, even if they choose to ignore it.
* Encourage him (ideally with input from a dietitian trained to deal with cultural issues) to eat foods that are high in dietary fibre (such as whole grains, fruits and vegetables) and have a low glycaemic index (such as beans and pulses) at the pre-dawn (Suhur) and sunset (Iftar) meals to promote glycaemic control.
Discourage him from eating foods with a high glycaemic index (such as more than three dates, which are traditionally used to break the fast) until about half an hour after taking drugs to minimise sharp rises in blood sugar at sunset.
* If blood glucose is well controlled by diet alone, advise him that fasting is safe. Scientific findings revealed that blood glucose and pressure can be controlled by fasting.
* Self monitoring of blood glucose is essential for safe fasting in patients taking antidiabetic drugs, particularly before and after the pre-dawn and sunset meals.
It should guide the individual tailoring of treatment regimens described below.
* To minimise the risk of hypoglycaemia, advise patients taking oral hypoglycaemic agents as follows:
If taking a long acting sulphonylurea, switch to a short acting preparation or metformin, or both
If a single daily dose is used, take this with the sunset meal
If two or three doses are taken each day, take half the normal evening dose before dawn and the normal morning (and any midday) dose after sunset.
Advise patients taking insulin as follows:
If a once daily dose is used, switch to a twice daily regimen
If a twice daily regimen is used, take half of the evening dose before dawn and the normal morning dose after sunset
If basal bolus insulin is used, reduce the long acting component to two thirds of normal, split into two equal doses taken during the sunset and pre-dawn meals. Take the rapid acting component as before, but omit the middle dose.
* Emphasise the need to carry dextrose or glucose tablets at all times to treat hypoglycaemia; explain the importance and legitimacy of breaking the fast in emergency situations.
* Encourage moderate exercise, patients are not advise to pray special night prayers, if they advised by consultant that health will deteriorate.
* Arrange for a review one week into Ramadan or earlier if concerns arise.
If you need further assistance on detailed about what issues and what you should do please refer your doctor firsts and get the assistance, please refer the article which was published in British Medical Journal Consultation section in the year of 2007.
The writer is a Senior Lecturer, Medicine and Allied Science Faculty, Rajarata University
Courtesy - Daily News by Faiz Marikar
