Managing Type 1 Diabetes in Ramadan

Ramadan is the holy month of praying and fasting for Muslims all over the world. However it may become challenging for children with Type 1 Diabetes who are on insulin. These are a few ways to fast and maintain sugars in normal range.

Q1) Which are the people who can exempt from fasting ?

A1) Ramadan is the holy month of observing fasting by Muslims. However managing blood sugars may become difficult in the following group of people :

  • Young Children who have not attained puberty (generally < 12yrs )
  • Elderly patient
  • Children who are sick, unwell or have underlying medical conditions
  • Children who have learning difficulties
  • People who are travelling
  • Women who are pregnant, breastfeeding

Q2) What are the risks associated with fasting ?

A2) Risks associated with Fasting in children with Type 1 Diabetes depends on the blood glucose control maintained, compliance of taking insulin and adequate monitoring.

The risks commonly seen are :

  • Hypoglycemia (low blood sugars)
  • Diabetic Ketoacidosis (due to missing insulin doses and fasting)
  • Hyperglycaemia (high blood sugars)

Q3) What are the things to keep in mind while fasting ?

A3) Before starting to fast during Ramadan patient should be aware of the following :

  • Blood sugar monitoring :
    It should be done more frequently in patients doing self pricking with glucometer, CGM (sensors) helps in continuous monitoring. Premeal aand 2 hours postmeal and anytime the child feels tired, sweating, or any other symptoms of hypoglycemia.
  • What to eat in Suhoor/ Sehri (predawn meal)
    It is the most important meal should not be skipped, it should include starchy, high carbohydrate like wheat, rice, cereals (including food with low glycaemic index); Fibres and proteins should be added to food - dals, chickpeas, rajma. Fruits and vegetables should be incorporated as well. Carb counting will be helpful to keep blood sugars in check.
    Remember to drink lots fluids (uncaffeinated, non sugar) during non fasting time to prevent dehydration.
  • What to eat for Iftar (fast break)
    Most people traditionally break the fast with Dates and water. Water should be consumed in adequate amount. Traditionally fast is broken with dates. One large seedless date weighs about 15 grams and provides 10gram Carbs( advisable to limit the date intake to 1)
    Fried and sweet food should be taken in moderation. Keep up your intake of water to prevent dehydration.
    Insulin should be given based upon the premeal sugars and carb counting
    after discussion with your endocrinologist

Q4) Important points to remember while fasting.

A4)

  • Blood sugar monitoring and Carb counting should be continued intensively during fasting and Insulin doses should be adjusted according to the blood sugar and meals eaten.
  • Drink lots of fluid to prevent dehydration.
  • Discuss your diet and insulin regime with your Endocrinologist prior to start the fast to stay healthy.