Diabetes Patients need to Manage Risks while Fasting during Ramzan, say Experts

NEW DELHI:
Ramzan, the month of fasting in Islam, began Tuesday and health experts have warned those with diabetes to manage risks while fasting as it can complicate the condition.

Diabetes patients need to manage risks while fasting as it adds up to potential health hazards that include dehydration and acute metabolic complications among others, experts said. Dr Satish Koul, senior consultant and director at Narayna Hospital, Gurgaon, said when diabetic patients decide 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 our body initially uses stored sources of glucose and then later it breaks down body fat as the next source of energy,” Dr Koul said.

The severity of diabetes can be gazed by the alarming statistics by IDF Diabetes Atlas, 2017, that states, “Diabetes kills one person every eight seconds, around the world. Worldwide, 451 million people are diabetic out of which 72.9 million are in India.”

Kerala has the largest number of diabetes patients followed by Tamil Nadu and Punjab, according to endocrinologists and diabetologists.

“It is important to keep a tab 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,” Dr Koul said.

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, he explained.

Dr Rajesh Kesari, endocrinologist at Total Care Control Diabetes Care Centre, Delhi, said fasting should not be done without consulting a doctor.

A patient should plan a visit to the doctor six to eight weeks in advance to get an overall assessment to decide his or her risks during fasting, Dr Kesari said, adding it is important for choosing healthy options while breaking fast, regular monitoring of sugar level, learning to identify symptoms of high or low sugars are crucial during fast.

Dr Ajay Kumar Ajmani, senior consultant endocrinologist at BLK Super Speciality Hospital said all diabetic patients who fast during Ramzan should undergo evaluation for one or two months before the start of spiritual fasting to determine their level of diabetes.

“Healthcare 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,” he said.