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Managing Diabetes During Ramadan

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KUALA LUMPUR – With Ramadan just around the corner, many Muslims are preparing themselves physically and mentally in anticipation of it.

Fasting in Ramadan is one of the five pillars and Islam and is therefore mandatory upon all able-bodied Muslims upon reaching puberty.

However, abstaining from food and drink can adversely affect the health of diabetics. They are at higher risk for complications like hypoglycemia (blood sugar level too low), hyperglycemia (blood sugar level too high), dehydration
while fasting.

Even though Islam exempts those with such medical conditions from obligatory fasting, many Muslim diabetics are still determined to perform the act of worship.

The Malaysian Endocrine and Metabolic Society (MEMS) President Prof Nor Azmi Kamaruddin said Muslim diabetics who wished to safely fast needed to first consult their physicians and make several lifestyle adjustments so that they would not suffer dire consequences following their choice.

When a person refrains from eating or drinking, several physiological changes start taking place in the body. The kind of changes that occurs corresponds with the duration of the fast.

“The body will go into a fasting mode at about eight hours after your last meal, when the gut finishes the absorption of nutrients from the food you have consumed.

“Simply put, the body will initially use stored sources of glucose (blood sugar) for energy, and then later in the fasting period it will break down body fat as the next source of energy,” Dr Azmi explained.

He said diabetics routinely face many challenges at the best of times, let alone in times that place extraordinary demands on the body.

The Epidemiology of Diabetes and Ramadan (EPIDIAR) study showed a 7.5-fold increase in hospitalisation of type 2 diabetes patients in Ramadan, due to severe hypoglycaemia.

A prospective local study also showed that the rate of hypoglycemia was 1.6 times higher during fasting compared to non-fasting periods.

The same EPIDIAR study showed a five-time increase in severe hyperglycaemia, or high blood sugar, requiring hospitalisation in type 2 diabetes patients. This may be due to a reduction in medication to prevent hypoglycaemia.

“It is critical that the patient seek medical advice if he or she intends to fast for Ramadan, whether they are afflicted with type 1 or type 2 diabetes.

This is to help the patient understand how to safely fast for this prolonged period, or whether fasting is indeed appropriate in certain cases,” said Prof Dr Nor Azmi.

Meanwhile, a Consultant Endocrinologist at the Putrajaya Hospital, Dr Masni Mohamad, said there was a need for patients and physicians to be educated about the management of diabetes during Ramadan to minimise complications.

“Muslims who are diabetic and want to fulfil their religious obligation for Ramadan may do so, but it is important that they receive advice and know how to fast safely,” she said.

Ramadan presented an opportunity for those with diabetes to learn how to better manage their condition, not only for Ramadan, but for life, she said.

“Diabetics should visit their physicians several weeks before Ramadan to prepare for the fasting month. Spending this time with your physician will avoid the discomfort and anguish of possible adverse effects, and give you peace of mind that you can fast safely,” said Dr Masni.

It was also very important for physicians to advise patients of the risks of hypoglycaemia, hyperglycaemia and dehydration, ways of identifying the symptoms and when to stop fasting, should the need arise.

In addition to that, patients should also be advised on physical activities they could engage in as well as adjustments that needed to be made to the medication schedule, she said.

In cognisance of the rising number of hospital admissions for diabetes emergencies during Ramadan, the Health Ministry, MEMS and pharmaceutical multinational Novartis collaborated to publish a practical guide uniquely for Malaysian healthcare professionals overseeing fasting Muslim patients with diabetes.

The main objective of the guide is to provide a structured framework that will enable physicians to advise their patients on how to best manage their condition and minimise complications during Ramadan.

“The intention is to empower physicians when they speak to their diabetic patients when preparing them for the fasting month,” said Dr Zanariah Hussein, a Consultant Endocrinologist at the Putrajaya Hospital.

Dr Zanariah added that the guide would be made available to all healthcare professionals to help them better manage and prepare diabetic patients for a prolonged period of fasting.

“We would like to achieve an improvement in diabetes management during Ramadan, thereby reducing hospitalisation related to diabetic emergencies during Ramadan.

“This will be a clear sign that patients are receiving advice and are taking steps so that they can fast safely and fulfil their religious obligations with peace of mind.” – Bernama

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