As Muslims head into Ramadan—a month-long period of religious fasting that begins Saturday, May 27th —medical experts caution diabetics and their doctors to be aware of the dangers of fasting and to utilize a Web-based tool that helps them follow fasting rituals safely.
“There are 1.6 billion Muslims in the world and 148 million have diabetes, and that number is growing at a faster pace than in non-Muslims,” says Osama Hamdy, MD, Medical Director of the Obesity Clinical Program and Director of the Inpatient Program at the Joslin Diabetes Center, Harvard Medical School, who presented research on Ramadan fasting and diabetes at the American Association of Clinical Endocrinologists conference in Austin on May 4th. (In the U.S., there are about 3.3 million Muslims. 1 The effects of fasting during Ramadan—which requires no food or fluids from sunup to sundown—can include dehydration, hypoglycemia during fasting hours, and hyperglycemia after the big meal at the end of the day. “Some of the large, end-of-day meals, which may be eaten quickly because of hunger, can be as high as 1500 calories and usually includes sugary desserts specific to Ramadan,” he adds. The risk of diabetic ketoacidosis —when the body builds up ketones causing weakness, confusion, vomiting (it can be fatal) is 4 to 5 times higher during fasting in patients with type 1 diabetes, says Dr. Hamdy. Ramadan follows the lunar calendar, and thus occurs 11 days earlier every year. Because Ramadan falls during hot weather for several years in a row, it can increase the risk of dehydration. In fact, summer fasting periods can last up to 20 hours per day.
“Many physicians will tell their diabetic patients not to fast, but data shows 2 that 94% of those with type 2 diabetes will fast for at least 14 days anyways and 67% of those fast every day for the entire month,” says Dr. Hamdy.
The solution: In addition to working with their doctors to determine their risk (some patients may be too high-risk to fast at all), patients and doctors can log on to DarAlliance.org (Diabetes and Ramadan International Alliance) to access a Ramadan eating plan and diabetic management structure. These guidelines were created by diabetes specialists across the globe and approved by religious leaders. Users can click on one of 29 Muslim countries and select the practitioner information (guidelines for medical experts managing patients during Ramadan) or patient information to see culturally- and religiously-appropriate examples of meals that are safe and healthy during Ramadan, with a focus on getting the right amount of carbohydrates, fat and protein at meals and distributing carbohydrates evenly to minimize high blood sugar after meals. The site also includes tips about monitoring glucose, weight management, exercise and insulin adjustments. They can also access the information in Arabic.
Dr. Hamdy also recommends that patients do a trial fast three consecutive days before Ramadan to help them and their doctor adjust insulin dosage during fasting. “If a patient insists on fasting against medical advice, it is better for him or her to work with their physicians to adjust diabetes medications, know when to break fasting and how frequently and when to test blood glucose, as well as to listen to advice about nutrition, hydration and exercise,” says Dr. Hamdy.
Dr. Hamdy also co-chairs the International Diabetes Nutrition Group that developed the Transcultural Diabetes Nutrition Algorithm (tDNA), and is currently leading the effort to improve the quality of diabetes care across the globe through implementing an effective transcultural lifestyle intervention. “We are working to personalize the diabetes messaging in ways that take into consideration a person’s culture, whether that’s Mediterranean, Latin American, South Asian, Middle Eastern, Indian and so on.”
Disclosure: Dr. Hamdy has served as a consultant for Merck and Abbott Nutrition and is on advisory board of Astra Zeneca. He has received research support from the US Dairy Council.