For Muslims, the month of Ramadan is a month full of blessings and one that people look forward to. In this month all Muslims who meet the requirements are required to fast by not eating and drinking, which generally lasts 29-30 days and in Indonesia Ramadan fasting lasts about 13-14 hours each day and is done during the day. Then what about diabetics or better known as diabetics? Is it safe for a diabetic to fast during Ramadan?
A diabetic can generally carry out Ramadan fasting in full, only in certain diabetic groups who have a high risk of getting unwanted events, such as for diabetics with a previous history of experiencing acute ketoacidosis, recurrent episodes of hypoglycemia, and for those who taking certain medications for diabetes. For this reason, it is very good if before starting the fasting of Ramadan, diabetics first consult a doctor regarding diabetes and its treatment during the fasting of Ramadan which will be lived later.
Some of the risks that a diabetic can experience during Ramadan fasting include: coma due to blood sugar levels rising too high, blood sugar levels dropping so low (less than 70 mg/dL, called hypoglycemia) or conversely increasing very high (more than 300 mg/dL, called hyperglycemia), and lack of fluids which can be accompanied by blockage of blood vessels due to clotting of platelets and even a stroke can occur. Considering that some of the risks mentioned above can occur in diabetics during Ramadan fasting, it is necessary to make various preparations properly.
The preparations in question are that diabetics before carrying out Ramadan fasting should first consult with a doctor to identify the risks that a diabetic has if fasting, get an explanation regarding changes in activity patterns, eating patterns and the correct use of diabetes medications during Ramadan fasting, knowing correctly about how to monitor blood sugar levels (when is the right time to do it), know the symptoms of low or high blood sugar levels and what to do, know when to break the fast, and if you need to bring an identity card explaining that The person concerned is a diabetic who is fasting.
Meal or diet arrangements include food and drink during fasting. Drink enough water between iftar and sahur to avoid lack of fluids during fasting. Recommended foods for diabetics during Ramadan fasting are foods that do not contain carbohydrates or simple sugars which will be easily absorbed so that they quickly increase blood sugar levels, contain lots of fiber, the amount of food is adjusted according to the calorie count needed which is divided into 3- 4 meals.
Treatment of diabetes in the form of oral medication or injections is still used even though an adjustment in the dose of the drug to be used is necessary, including the possibility of a change in the time of taking or injecting the drug. For this reason, it is better to consult a doctor first regarding the use of diabetes medications before fasting during Ramadan.
Monitoring blood sugar levels during fasting should be done regularly and recorded in a diary, and can be done up to 7 times a day (before and after sahur, midday, before breaking the fast and 2 hours after breaking the fast, and midnight) especially during the early days of fasting. and when you suddenly feel something uncomfortable and disturbing or in certain circumstances where symptoms of hypoglycemia or hyperglycemia arise.
When should a diabetic break his fast? A person with diabetes must immediately cancel their fast and be replaced by fasting on another day if their blood sugar level is very low or hypoglycemia, if their blood sugar level is very high or hyperglycemia, and if there is a worsening of co-morbidities such as hypertension or experiencing acute and severe illness. Signs and symptoms of hypoglycemia can range from mild to severe, including: hunger pangs, shaking with intense hunger, palpitations, cold sweats, headaches, and changes in consciousness and even coma. Signs and symptoms of hyperglycemia can range from mild to severe, including: frequency and greatly increased number of urinations, excessive thirst, sometimes breathing that becomes fast and deep, and disturbances of consciousness may occur.
Regarding physical exercise or exercise with light to moderate intensity, a person with diabetes can still do it during fasting in the month of Ramadan and can be done at any time, but it is better not to do it in the afternoon before breaking the fast. Physical exercise during the fasting month of Ramadan should be done a few hours after breaking the fast and Taraweeh Prayer activities can be included in the category of physical exercise.
Given the importance of some of the above, it is highly recommended for diabetics to consult before doing Ramadan fasting to do an assessment of the risks that might occur during Ramadan fasting, besides that it is important to do fasting exercises for approximately 6-8 weeks before fasting. The real Ramadan and do things that are recommended during fasting, so that things can be predicted that can happen during fasting later and make improvements. Fasting exercises do not have to be done every day, but can be done for example a week and two days of fasting (Mondays and Thursdays).
Happy fasting Ramadan safely for all those with diabetes!
Article written by dr. Wardhana, Sp.PD, KEMD, FINASIM (Internal Medicine Specialist - Metabolic, Endocrine & Diabetes Consultant at EMC Alam Sutera Hospital).