Type 1 diabetics advised to undergo medical assessment

Patients should adhere to strict diet and insulin regimen during fasting hours

As we come closer to the holy month of Ramadan, doctors recommend patients of all ages suffering from Type-1 diabetes to seek medical advice and assessment before fasting. Type-1 diabetes is a condition that was once known as 'juvenile' diabetes or 'insulin-dependent' diabetes, is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy. 
People suffering from recurrent hypoglycaemia, poor diabetes control, brittle diabetes, chronic kidney disease, acute illness, advance macrovascular complications must refrain from fasting as they could be at risk of developing acute complications.
"Pre-Ramadan medical assessment for patients suffering from Type-1 diabetes is highly recommended as it will help them undergo the necessary preparations to fast as safely as possible.

The assessment includes evaluating the physical status, the glycaemic status, conducting appropriate blood studies of the patient and examining any acute or chronic complications. According to the result of the assessment, the patient will be advised to alter their diet and follow a specific insulin regimen," said Dr. Sarla Kumari, Specialist Physician Diabetologist, Canadian Specialist Hospital. 
Apart from the medical assessment, doctors emphasise the importance of Ramadan-focused medical education, especially among children suffering from Type-1 diabetes. Ramadan medical education focuses on the signs and symptoms children should watch out for while fasting. In case of extreme fatigue, blurred vision or a severe headache, it is recommended to end the fast and consume prescribed medications. 
Additionally, it also educates the patients about meal planning, timely glucose monitoring, insulin and medications regimen and importance of hydration. Close follow-up with the physician is essential to reduce the risk for development of complications.
Patients need to monitor blood sugar levels regularly monitored during fasting and non-fasting hours, especially during suhoor, at noon, during iftar, two hours after iftar and whenever they experience the symptoms related to hypoglycaemia. It's important to understand that the fasting must end immediately in case blood sugar falls below 70 mg/dl in the first few hours after the start of fast. Fast should also be broken if the sugar levels fall below 60 mg/dl or exceed 300 mg/dl anytime during the fast. 
 
Another concern associated with fasting is the ingestion of large amounts of food in a short duration, which is a common practice during Ramadan and may lead to elevated sugar levels. Patients suffering from diabetes are advised to break down their meals into two or three smaller meals and time them at proper intervals. Consuming smaller meals during the non-fasting interval may help prevent excessive postprandial hyperglycaemia.
"It is extremely important for diabetic patients to refrain from consuming sweets and sugary drinks during suhoor and iftar. During suhoor, starchy carbohydrates should be consumed that release energy slowly into the body. Fruits, vegetables, whole grains, dairy, pulses, chicken, meat and fish should be a part of the meal plan. Increased fluid intake is highly recommended to avoid dehydration during non-fasting hours," said Dr. Sarla.
Patients may engage in light physical activities during the non-fasting hours. However, excessive work-out or exercising should be avoided particularly during the few hours before the sunset meal as it may lead to hypoglycaemia. In patients with poorly controlled diabetes, exercise may lead to hyperglycaemia. 
"In severe cases, we advise Type-1 diabetes patients to avoid fasting as it may lead to the development of acute complications. However, with good glycaemic control and regularly self-monitoring blood sugar levels, most patients can reap the benefits of fasting," concluded  Dr. Sarla.

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