FASTING WITH DIABETES Manage your Diabetes during Festive Fasting

Diabetes has been seriously underrated as a global public health issue and the world can no longer ignore the biggest epidemic in human history. And with spiritual fasting – Diabetes adds up to the danger it brings for a patient.In India, festivities are filled all throughout the year. Most often these festivities are accompanied by extensive fasting, to- over indulgent-feasting which tend to botch with the healthy dietary plan.People with diabetes become more visible to the dangers of fasting or excessive feasting.The severity of diabetes can be gazed with the alarming statistics by IDF Diabetes Atlas 2017 that states “Diabetes kills 1 person every 8 seconds, around the world. Worldwide, 451 million people are diabetic out of which 72.9 million are in India”. Fasting may look like a tip of the iceberg but is a major triggering factor which worsens the condition for a diabetic. According to IDF Diabetes Atlas 2017, 693 million people are going to be affected by diabetes as it is expected to increase by 2045. Kerala has the largest number of diabetes patients followed by Tamil Nadu and Punjab, according to Endocrinologists and Diabetologist in the state.
Dietary advice during fasting for patients with diabetes

• Ensure meals are well balanced
• 45–50% carbohydrate
• 20–30% protein
• <35% fat (preferably mono- and polyunsaturated)
• Include low glycaemic index, high fiber foods that release energy slowly beforeand after fasting
E.g. granary bread, beans, rice
• Include plenty of fruit, vegetables, and salads
• Minimise foods that are high in saturated fats
E.g. ghee, samosas, pakoras
• Avoid sugary desserts
• Use small amounts of oil when cooking
E.g. olive, rapeseed
• Keep hydrated between sunset and sunrise by drinking water or other non-sweetenedbeverages
• Avoid caffeinated and sweetened drinks
According to Dr. R. S. Hariharan said, “With diabetic patients deciding to fast, the importance of practical diabetes and spiritual fasting guidance becomes evident. Potential health hazards include hypoglycaemia, hyperglycaemia, dehydration and acute metabolic complications such as diabetic ketoacidosis.During fasting our body’s system goes through a lot and that depends on the length of the continuous fasting. When we fast the body initially uses stored sources of glucose and then later it breaks down body fat to use the next source of energy. It is important to keep a tap on your blood glucose levels as the chances are that during fasting your blood glucose levels may drop too low. It is advisable to keep your doctor informed if you decide to fast."
In case the fasting period is longer than 12 hours, then there can be a state of intermittent glycogen depletion and repletion. In practice, most patients who take their first meal at dawn are in a state of glycogen depletion by late afternoon, at which point ketogenesis occurs. If a meal is skipped, then it can further lead depletion of glycogen stores and ketosis much earlier in the fasting day.
According to Dr. A.Nanditha Arun , said “In Type 2 diabetes you see that people are generally obese and have large abdomens. As the patient gain weight, it gets worst. There is a need to take more insulin, which means to gain more weight. Resulting in a vicious cycle. A moderate and properly consulted intermediate fast can be good got diabetic patient for losing weight, and help control the blood glucose, blood pressure, and cholesterol levels. However, fasting should not be done without consulting a doctor. Patient should plan a visit to the doctor 6 – 8 weeks ahead to get an overall assessment to decide his or her risks during fasting.It is important for Choosing healthy options while breaking fast, regular monitoring of sugars at home with a glucometer, learning to identify symptoms of high or low sugars are crucial during the fast.”
Do’s while observing a fast for diabetic patient
• Consult your doctor prior to, during and post fasting
• Include high fiber food in your diet
• Drink plenty of water and sugar-free beverages during non-fasting hours
• Monitor your blood sugar levels multiple times daily, especially if you are taking insulin
• Include plenty of fruits, vegetables in your meals

Don’ts while observing a fast for diabetic patient
• Do not ignore any of the warning signs of low or high blood sugar levels and consult your doctor immediately
• It is advisable not to continue fasting if blood sugar level goes below 70 mg/dL or if it goes above 300 mg/dL
• Limit the intake of fried food, sweets, and caffeinated drinks as much as possible
• Avoid excessive exercise, especially during fasting hours
• In any case, do not stop taking medicines without consulting your doctor
The spread of diabetes to economically disadvantaged sections of society is a matter of great concern, warranting urgent preventive measures. The diabetes epidemic seems to be maturing in the more economically advanced states of India, with diminution of the prediabetes pool raising the likelihood of stabilization of diabetes prevalence in the near future in these states. However, the spread of the epidemic to economically disadvantaged sections of society is a matter of great concern in India, where most diabetes treatment expenses are borne out of pocket by patients. Preventive measures need to be directed at these individuals, who have previously been deemed at fairly low risk of developing diabetes, as well as to rural areas where diabetes awareness remains low.1
All diabetic patients who fast during Ramadan should undergo an evaluation for 1 or 2 months before the start of Ramadan to determine their level of diabetes control and the presence of acute and chronic complications of diabetes and other comorbid conditions.Specific attention should be devoted to patients' overall well-being and to the control of their glycemia, blood pressure, and lipids. While fasting is a commendable spiritual practice, it’s one that could come with major health risks for people who have diabetes.  To be most helpful, dietitians and healthcare providers can ensure diabetes patients of faith and their spiritual communities understand the adverse effects of fasting.Raising the general awareness of Ramadan and diabetes should strengthen the harmony between medical and religious advice.Health care professionals should be trained to deliver a structured patient education program that includes a better understanding of fasting and diabetes, individual risk quantification, and options to achieve safer fasting.The educational program should include advice on the timing and intensity of physical activity during fasting.
Reference:
International Diabetes Federation (IDF), in collaboration with the Diabetes and Ramadan (DAR) International Alliance IDF DAR, Diabetes and Ramadan: Practical Guidelines, 2016