RAMADAN

Estimated for 2015 to be between June 17 to July 18

Information about fasting for people with diabetes
(Click here to download a printable PDF copy)

About Ramadan

Ramadan (also known as Ramadhan or Ramzan) is the ninth month in the Islamic calendar. It is a period of prayer, fasting, charity-giving and self-accountability for Muslims in New Zealand. The first verses of the Koran (Qu'ran) were revealed to the Prophet Muhammad (also written as Mohammad or Muhammed) during the last third of Ramadan, making this an especially holy period.

Many Muslims (except children, the sick and the elderly) abstain from food, drink, and certain other activities during daylight hours in Ramadan. As the month of Ramadan follows the lunar calendar, the fasting month is brought forward by about 10 days each year, which means that over time the season in which Ramadan falls changes. Here in New Zealand it falls in June – July in 2015 when the daylight hours are shorter.

PLANNING FOR RAMADAN

We are unique individuals with unique needs whose bodies react in a unique way to the environment we are in. As a result, the effect of fasting on the body will differ from person to person and will also depend on the type (if any) of diabetes medicine you take.

There are a number of risks associated with fasting and it is important to consider these risks carefully before Ramadan. Considering these will inform your choice of whether to fast or to revert to another option, such as donating the amount of money you spend on your daily food to the poor.

Some of the risks are listed below, but it is recommended that you discuss these risks in detail with your health care team prior to making the decision to fast or not.

Food

Changing eating patterns during Ramadan increases the risk of hypoglycaemia (low blood glucose levels) and hyperglycaemia (high blood glucose levels).

Talk to your health care team to find out how your medication might put you at risk for low blood glucose during the day and discuss how to prevent this.

Plan your Sehri and Iftar meals properly in advance to ensure there is not a spike in your blood glucose. The risk here is that you may take in too much sweet food/drink and that you don’t manage to keep your portion sizes moderate.

Physical activity

Rigorous exercise, especially before Iftar can create a risk of hypoglycaemia (low blood glucose levels) may be increased, particularly if you are taking medication or insulin.

Dehydration:
This may not be as much of a problem when fasting coincides with shorter, cooler days but it could be a problem during the longer, hotter summer days. It could also be a problem if your daily activities or work involve heavy physical exertion. A possible solution in this case, is to drink sugar free and caffeine free drinks frequently after Iftar and before dawn.

Medications

It is very important to schedule an appointment with your health care team, well in advance of Ramadan (we recommend at least 2 months in advance). During this appointment you could discuss the risks of fasting as well as the changes that you may have to make to your medication plan, the timing of your medication and your eating habits for Sehri and Iftar.

Sehri

just before sunrise

Iftar

the end of the fast after sunset

SAFE FASTING

Managing Diabetes During Ramadan

If you have diabetes, you may have questions about how fasting will affect your health, especially if you plan to fast during the holy month of Ramadan. You may wonder whether it is safe to fast; how you will manage your medication; how often you should monitor your blood glucose; what the best food choices are for Sehri and Iftar, and so on.

If you wish to take part in this important spiritual practice please liaise closely with your healthcare team, keep up good eating habits and monitor your situation carefully on a regular basis.

If your diabetes is controlled by diet and physical activity alone, you should be able to fast safely as long as you plan your meals at Sehri and Iftar carefully and you use low-calorie drinks and limit sweets and fried foods.

If your diabetes is controlled by medication, it is crucial to plan well in advance with your health care team in order to make sure you fast safely.

Type 1 diabetes and type 2 diabetes

There are significant differences between the way in which people with type 1 (requires insulin) and type 2 (may require insulin) react to fasting. Please consult your healthcare team.

If you are on any type of medication please consult with your healthcare team.

Understanding our body

Each individual is unique, however here is a general summary of what happens to the body during fasting:

diagram fasting

 

Hypoglycaemia

Low blood glucose levels

Blood glucose levels below <4.0 mmol/L

Hyperglycaemia

High blood glucose levels

High blood glucose levels greater than 15 mmol/L and not settling

 

DURING RAMADAN

Before fasting: Please remember to consult with your healthcare team on healthy eating, physical activity/exercise and diabetes management that is suitable for you and your situation.

Food - meal planning

The diet during Ramadan should be a healthy balanced diet. Plan meals carefully in advance and eat in moderation.

  • Try to have the meal at Sehri at the proper time just before sunrise, not at midnight. This will spread out your energy intake more evenly and result in more balanced blood glucose when fasting.
  • Slow energy release foods such as wheat, semolina, beans, brown rice (white rice is a fast release food) should be taken before and after fasting, whereas foods high in saturated fat (such as ghee, samosas, and pakoras) should be minimised.
  • Include fruits, vegetables, dhal (lentils) and yoghurt in your meals at Sehri and Iftar.
  • Be aware of the effects that traditional rich foods associated especially with Eid-ul-Fitr may have on your diabetes management and weight.
  • Try not to fall into the habit of eating large amounts of food rich in carbohydrates and fats, such as ladoo, jelaibi or burfi or bacalavas and other Arabic sweets especially at Iftar. This will help avoid hyperglycaemia (high blood glucose).
  • Limit fried foods such as paratha, puri, samosas, chevera, pakoras, katlamas, fried kebabs and bombay mix (chivda).
  • Use small amounts of monounsaturated oils (such as rapeseed or olive oil) in cooking. Measure the amount of oil used in cooking (use 1–2 tablespoons for a four-person dish).
  • Choose sugar-free types of drinks or water to quench your thirst and avoid adding sugar to drinks.

Physical activity

Continue to exercise regularly -

  • Exercise is important for everyone and it is important to keep exercising during Ramadan but limit physical activity during fasting hours and be more active after sunset.
  • Rigorous exercise, especially before Iftar can create a risk of hypoglycaemia (low blood glucose levels) may be increased, particularly if you are taking medication or insulin.
  • Tarawaih prayers (the series of prayers after the sunset meal) should be considered as part of the daily exercise regimen as they involve gentle exercise of standing, bowing, prostrating, and sitting.
  • Plan to get enough breaks during the day to help avoid low blood glucose levels.
  • If you regularly test your blood-glucose using a meter, it is also a good idea to check your blood glucose levels before and after exercise.

Medications

If you take any kind of medication for diabetes or other medical conditions, discuss a plan with your healthcare team.

If you are fasting there will be a need to adjust the timing of medications to fit in with altered meal patterns and also avoid taking tablets during daylight hours – liaise closely with your healthcare team.

Diabetes and Blood Glucose monitoring

Longer gaps between meals and greater amounts of foods – in particular, a higher intake of carbohydrate – may mean people with diabetes can experience large swings in blood glucose levels during Ramadan.

People with diabetes should be aware of the warning symptoms of dehydration, hypoglycaemia (low blood glucose), and hyperglycaemia (high blood glucose) and should stop the fast as soon as any complications or acute illness occur.

If you have been advised to check your blood glucose using a meter (finger-prick test) -

  • It is considered that blood glucose monitoring does not constitute the break of fast (this is for individual discussion with your religious advisor).
  • Blood glucose testing with a blood glucose meter should be done when
    • you suspect you have symptoms of hypoglycaemia (low blood glucose levels),
    • you suspect you have symptoms of hyperglycaemia (high blood glucose levels). Your healthcare professional will probably advise you to break your fast if hypoglycaemia is confirmed on blood glucose testing,
    • you are unwell (e.g. have a fever).

Testing at other times may be advised by your healthcare professional only if you are able and willing to adjust your diabetes treatment regimens, such as insulin dosage.

Blood glucose levels

  • Normally the human body keeps its blood glucose level very stable between 4.0 mmol/L – 7.5 mmol/L
  • Hypoglycaemia (low blood glucose levels) blood glucose levels below <4.0 mmol/L
  • Hyperglycaemia (high blood glucose levels) high blood glucose levels greater than 15 mmol/L and not settling

Your healthcare professional will advise you on the recommended blood glucose levels for you.

 

FREQUENTLY ASKED QUESTIONS

Food

Will I lose weight during Ramadan?

Weight losses of 1.7 kg to 3.8 kg have been reported in normal weight individuals after one month of fasting during Ramadan. Often overweight people lose more weight than people with a standard weight or underweight people. However, since many people eat very rich food during Ramadan and often reduce their daily activities for fear of hypoglycaemia, some patients have actually gained weight during Ramadan.

Could dehydration become so bad that you have to break the fast?

Yes. You could become very dehydrated if you do not drink enough water before the fast. Poor hydration can be made worse by weather conditions, and even everyday activities such as walking to work or housework.

If you produce very little or no urine, feel disoriented and confused, or faint due to dehydration, you must stop fasting and have a drink of water or other fluid. Islam doesn't require you to harm yourself in fulfilling the fast. If a fast is broken, it will need to be compensated for by fasting at a later date.

Physical activity

Should I rest during the day?

This will depend on your personal circumstances. In some countries it is considered that fasting should not be used as an ‘excuse’ to limit activity – that you should seek to complete your normal day’s work. Just remember to plan to get enough breaks during the day to help avoid low blood glucose levels.

Medications

Should I stop taking medicine during Ramadan?

Consult with your health care team to work out how to change dosing so that you optimise the effects of the medication.

Blood Glucose

Should I check my blood glucose during the day? I’m worried I may break the fast if I do.

It is important to monitor blood glucose levels especially to identify a low or high blood glucose level.  It may be dangerous to continue to fast if you develop low or high glucose levels.

How can I manage low blood glucose?

If glucose levels do fall below 4.0 mmol/L, take 15 grams of carbohydrate in the form of one of these:  4 glucose tablets, a glass of fruit juice, 8 jellybeans, or 300 ml of Lucozade.  Wait 15 minutes and recheck again.  Follow with a snack if the evening meal is not for more than an hour.