MAY-JUNE , 2022 | THE HEALTH

BY PROF DR NORLAILA MUSTAFA

There are about 1.9 billion Muslims globally , and the number keeps increasing by about three per cent yearly . In Malaysia , about 62 per cent of the population are Muslims .

Although the Quran exempts sick people from the duty of fasting , many Muslims with diabetes are keen to fast . It is important for people with diabetes to discuss with their doctors before deciding to fast .

This includes understanding their diabetes control , the risk of fasting to their health , how to reduce this risk and whether the risk is too high to perform the Ramadan fasting . If someone cannot perform the Ramadan fasting for health reasons , they should discuss with the Imam and ask for advice about an alternative to fasting .

The average of Ramadan fasting in Malaysia is about 14 hours , which means abstaining from eating and drinking from after Suhor ( sunrise ) until Iftar ( breaking the fast at sunset ). People with diabetes are encouraged to drink a lot of water after breaking their fast to prevent dehydration .

Decreased food intake is a well-known risk factor for developing hypoglycaemia ( low blood sugar , < 4.0 mmol / L ) especially when there is no proper adjustment with anti-diabetic medications , both oral and injectable . Other known risks associated with fasting among people with diabetes are hyperglycaemia ( high blood sugar ) and thrombosis ( occlusion of the vessels due to the formation of blood clots ).

Population-based studies ( EPIDIAR Study ) have shown that both risks of hypo and hyperglycaemia are high during fasting Ramadan in people with diabetes . This is true if the diabetes is not well controlled . Proper education about fasting is not given to them .

Monitoring blood sugar levels is important

Symptoms of low blood sugar or hypoglycaemia are lightheadedness , sweating , feeling tired , feeling hungry , tingling lips , feeling shaky or trembling and a fast or pounding heartbeat ( palpitations ). In severe cases , hypoglycaemia can also cause seizure , loss of consciousness and lead to coma .

Hyperglycaemia during Ramadan fasting can be due to excessive reduction of medication dosages to prevent hypoglycaemia . An increase in food or sugar intake during non-fasting hours ( after Iftar until Suhor ) also had

significantly higher severe hyperglycemia rates . Therefore , patients with diabetes who want to observe Ramadan fasting must be adequately educated by their doctor on the medication dosage adjustment and blood sugar monitoring . Symptoms of hyperglycaemia include being extremely tired , thirsty , passing a lot of urine , blurred vision , dryness of mouth and skin and headache . Severe hyperglycaemia will also lead to dehydration and can cause acute kidney failure .

People with diabetes tend to take the importance of monitoring blood sugar for granted and only do so once they have symptoms of hypo or hyperglycemia . The blood sugar monitoring should be done as often as possible during fasting

and be sure to have the monitoring strips available at all times .

If the blood sugar drops below 4.0 mmol / L and yet there are no symptoms of hypoglycaemia , you must break your fast . Failing to do so will be detrimental to your health as the blood sugar can drop further and lead to a coma .

Hypoglycaemia occurs quite often , as people with diabetes will still take diabetic medications . Similarly , if your blood glucose is high and you have symptoms of hyperglycaemia as mentioned above , you must break your fast too .

Watch your salt intake too

It is important not to skip the Suhor meal , just before dawn . You are encouraged to drink a lot of water to prevent the risk of dehydration . Healthy eating such as taking high fibre foods like cereal , oats , or brown rice is more slowly absorbed and has a low glycemic index .

This will help maintain your blood sugar within a normal range during fasting . A good source of protein like dhal and beans are also high fibre and good for health . Although it is an early morning meal , combining your carbohydrate intake with fruits and vegetables is important for your health and blood sugar control .

Breaking fast at sunset ( Iftar ) with dates is Sunnah and is encouraged in Islam . Dates are high in fibre but also a rich source of carbohydrates . You can only take two large dates combined with a large glass of plain water to maintain your sugar level .

Avoid sugary drinks and reduce all the unhealthy desserts during iftar as this will easily raise your blood sugar . Taking an oily foods or fried foods in moderation is important as this will lead to weight gain despite fasting a whole month during Ramadan .

Watching your salt intake is also important to maintain your blood pressure within the normal range . Remember , you are not only to maintain your blood sugar level but your overall health is of utmost importance .

Lastly , anti-diabetic medication adjustment either oral tablets or injectables is important to prevent hypoglycemia during fasting . It would be best to discuss this with your own doctor , especially the insulin dose and timing of injection .

Although it is mandatory ( wajib ) for all Muslims , Fasting during Ramadan is not supposed to be detrimental to your health . — The Health

Prof Dr Norlaila Mustafa is Deputy Dean ( Postgraduate ), Faculty of Medicine and Senior Consultant Physician and Endocrinologist , Universiti Kebangsaan Malaysia Medical Centre .

Made By Duopharma Biotech , the pharmaceutical company with Halal products .

Halal Pharmaceutical Company of the Year Frost & Sullivan Malaysia Excellence Awards

halal4pharma . com