Are the risks the same for type 1 diabetes and type 2 diabetes? If no, what are the differences?
Guidelines suggest that people with type 1 diabetes are at high risk for diabetic ketoacidosis (DKA). There are certainly people who live with type 1 diabetes who should not fast. This includes people with an HbA1c greater than 9%; people who have hypoglycaemia unawareness, renal disease, macrovascular complications and pregnancy. The same rules apply to those with type 2 diabetes.
Many people with type 1 and type 2 diabetes who insist on fasting do well under supervision and with good compliance and backup support.
Is self-monitoring of blood glucose allowed during Ramadan?
Self-monitoring of blood glucose is allowed during fasting. In fact, it improves safety and blood glucose management. People are encouraged to test their more often during fasting. Experts have also almost unanimously confirmed that self-monitoring of blood glucose does not affect fasting. It is also advised to check blood glucose when symptomatic, and to break the fast if blood glucose is <70 mg/dl.
Typically, Ramadan meals are very heavy in calories and also may contain high sugar and high fat foods. What should people with diabetes do during these meals?
The idea that “post fast” at the Iftar meal ought to be heavy is more of a behavioural attitude. Trendy feasting has nothing to do with Ramadan or fasting. In fact it is against the spirit of fasting that people have heavy meals before and after the fast.
Nonetheless, if people have to have higher calories, we suggest medicinal dose adjustments accordingly. In Ramadan, a daily 45 minutes of exercise after Iftar prayer is commonly observed. This is a good starting point for those who are not exercising regularly to develop an exercise plan after Ramadan. Furthermore, there is an evidence that those overweight who comply to the dietary advice, lose weight significantly during Ramadan.
How can healthcare professionals help guide people living with diabetes who decide to fast?
Key components of a Ramadan-focused educational programme include: risk quantification, blood glucose monitoring, fluids and dietary advice, exercise advice, medication adjustments, and when to break the fast.
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