PETALING JAYA: On average, Muslims in Malaysia fast for 13 hours a day during Ramadan.
However, for those with diabetes, abstaining from food and drinks all day can increase the risk of hypoglycemia, a condition where the blood sugar or glucose level drops below the normal range.
Endocrinology and diabetes consultant physician at KPJ Damansara 2 Specialist Hospital Dr Sharifah Faradila Wan Muhammad Hatta said patients with health problems, especially diabetes, can be exempted from fasting.
“However, many Muslims with diabetes feel committed to Ramadan and insist on fasting so they are advised to consult their doctor and practice fasting before the start of Ramadan,” she said, adding that they are also advised to pick the food and drinks they wish to consume for the predawn (sahur) and breaking of fast meals carefully to ensure they are able to keep their blood sugar levels steady and get the vitamins and nutrients they need.
Dr Sharifah Faradila said hypoglycemia is a dangerous condition in which the glucose level drops below the normal range of 4 millimoles per litre (mmol/L), adding that patients with Type 1 and Type 2 diabetes are at high risk of developing this condition.
“They must break their fast immediately if their blood glucose level drops below 4 mmol/L and treat it by consuming 15-20 grammes of carbohydrates such as fruit juice or four to five jelly babies (a type of candy), followed by something starchy such as a sandwich,” she said.
If left untreated, severely low blood sugar can be life-threatening and can lead to complications such as multiple organ failure, cardiac arrest, permanent brain damage and coma.
Dr Sharifah Faradila said after breaking fast, diabetics are also at risk of experiencing hyperglycemia, a condition where the blood glucose level spikes too quickly to over 10 mmol/L.
“This can happen if they miss their usual prescribed medication or eat larger portions of carbohydrates or sugary foods or if they have been less physically active than normal. High blood sugar levels can increase one’s risk of dehydration and make them feel dizzy and tired,” she explained.
Types of diabetes
On average in Malaysia, one in five adults lives with diabetes, according to Dr Sharifah Faradila.
There are three main types of diabetes, namely, type 1 and type 2 and gestational diabetes which occurs in certain pregnant women.
“Type 1 diabetes is a chronic condition, usually diagnosed among children and teens where the pancreas is unable to produce insulin or can only create a limited amount of it,” she said.
Type 2 diabetes occurs when the body becomes resistant to insulin or is unable to produce enough of it. It is the most common diabetes in Malaysia, with over 90 percent of patients aged 18 and above diagnosed with type 2 diabetes.
Dr Sharifah Faradila said insulin, an essential hormone made by the pancreas, helps the body to absorb glucose as the primary source of energy for the body.
“Without insulin, the glucose level in the body can get too high and cause short-term issues such as dehydration, weight loss and ketoacidosis, which can also cause damage to vital organs in the long run,” she said.
She said diabetic patients are advised to check their blood sugar levels frequently throughout the day if they choose to fast during Ramadan.
“This is a must, especially for patients who require insulin. It’s recommended that they check their blood sugar levels at least six times a day, that is, prior to consuming the predawn meal; two hours after the predawn meal; at noon; before breaking fast; two hours after breaking fast; and just before going to bed,” she said.
She also said patients on insulin should be given instruction on how to monitor their blood glucose levels as well as how to adjust their insulin doses based on the glucose goals discussed with their doctor before the start of Ramadan.
Diet and meals
Pointing out it is important for diabetic patients to eat a healthy and balanced diet during Ramadan, Dr Sharifah Faradila said it is advisable for them to eat food such as brown rice, beans and wholewheat bread that have a low glycaemic index and contain high fibre and release energy slowly before and after fasting.
“They must not skip the sahur meal and have it as close as possible to the cut-off time because it will be more than 13 hours before they can break their fast,” she said.
“They must drink plenty of plain water and avoid consuming sweet drinks during sahur and while breaking fast. But they can enjoy a small piece of fruit or a date to raise their blood glucose levels safely.”
Meanwhile, KPJ Damansara 2 Specialist Hospital consultant gastroenterologist and hepatologist Dr Jaideep Singh said the most common problems of the digestive system endured during Ramadan are acute gastritis and GERD (gastroesophageal reflux disease). These are caused by prolonged fasting and are seen most in those who already have gastric problems, and the consumption of large fatty meals and spicy food while breaking fast worsens their symptoms.
He said these problems can be prevented by drinking enough water for hydration, eating small amounts of food frequently, avoiding smoking and taking gastric medications as prescribed.
“But avoid fizzy drinks as they contain too much sugar while the gases from sugar fermentation may cause bloating. Avoid overeating because eating a big meal suddenly can cause stomach ache and severe acid reflux.
“Also, try to avoid sleeping on a full stomach and allow enough time for the undigested food to go through the stomach and gut adequately. Avoid too much chili, hot spices, fried and oily food, as well as junk food,” he added. – BERNAMA
