Diabetes Management During Ramadan

Jul 3. 2020

Ramadan can be a major challenge to one’s dietary pattern, with difficulties arising from an inappropriate diet or as a consequence of overeating and insufficient sleep. If you already follow a healthy and balanced diet, you do not need to deviate much.

If you have diabetes and wish to fast during Ramadan, you should undergo a medical assessment and engage in a structured education program to undertake the fast as safely as possible. The assessment should take place 1–2 months before Ramadan as fasting may lead to hypoglycemia, hyperglycemia with or without ketoacidosis, thrombosis and dehydration. It is important that the decision about whether to fast or not is made on an individual basis, and in consultation with the diabetes care team.

Check your blood glucose regularly

Blood glucose monitoring and insulin injections do not break the fast and are important. They are your window to know your blood glucose levels and manage your diabetes. Changes in eating habits during Ramadan may affect your blood glucose and it is therefore important to check blood glucose levels regularly.

Test your blood glucose 6 times a day:

1. Suhoor (pre-dawn meal)

2. Morning

3. Midday

4. Mid afternoon

5. Iftar (sunset meal)

6. 2 hours after Iftar

You should also check your blood sugar any time you have symptoms of low or high blood glucose or are feeling unwell.

Break the fast if:

– Blood glucose is lower than 70 mg/dl (3.9 m mol/L), or
– Blood glucose is higher than 300 mg/dl (16.6 m mol/L)

It’s important to measure blood glucose again after 1 to 2 hours.

A healthy and balanced nutritional intake during Ramadan is recommended for everyone, but especially when you have diabetes or are prediabetic. Consuming large meals at Iftar and/or foods that are high in carbohydrates and fats should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing complex carbohydrates (slow digesting) may be advisable at Suhoor. The Iftar meal should be consumed as early as possible and contain whole wheat flour chapatis, vegetables and a meat/fish dish. A glass of milk or fruit at bedtime will maintain normoglycemia (normal concentration) till suhoor.
Suhoor should be eaten as late as possible, before the start of the fast and contain a high proportion of carbohydrates with fibre. This will help prevent hypoglycemia and give you energy throughout the day. Drink 8-10 cups of water between Iftar and Sahour meals.

Ramadan Nutrition Tips:

– Iftar should begin with water to rehydrate and 1- 3 dates to raise blood glucose.
Choose Deglet Noor dates over Medjool dates. A Deglet Noor date contains 20 calories and 5 grams of carbohydrates, while a Medjool date contains 66 calories and 18 grams of carbohydrates. Avoid eating more than three dates per day.
– When deciding what to eat for Iftar or Suhoor, choose healthy options that consist of all the macronutrients (carbohydrate, fat and protein).
Instead of going for fried food, try grilled chicken or fish with a side of vegetables and some rice or potatoes.
– Choose smaller portions, eat slower and enjoy the food.
– Try to cut back on how much dessert you have. Instead of having two or three kinds of sweets, only have one. A fried qatayef filled with walnuts contains on average 270 calories and 36 grams of carbohydrates. If you want an alternative to sugary desserts, have a small bowl of fruit with natural yogurt instead.
Add cinnamon instead of syrup to your qatayef dessert. One tablespoon (15 ml) of syrup contains 62 calories and 17 grams of carbohydrates.
– Increase water intake by eating hydrating foods. Try adding watermelon and strawberries to your suhoor meal or eat it as a sweet treat after iftar. Green salads contain plenty of hydrating vegetables, such as: cucumber, tomatoes and radish.
– Avoid caffeinated drinks such as coffee, tea, cola and energy drinks. Caffeine can make you urinate more often, which may lead to dehydration.Remember that soft drinks and lemonades with sugar will add calories to your diet.

Exercise is another good way to keep your glucose levels in check. Normal levels of physical activity may be maintained. However, excessive physical activity may lead to a higher risk of hypoglycemia and should be avoided, particularly during the few hours before Iftar. During Ramadan, it is best to do light or moderate exercise for at least 30 minutes between Iftar and Suhoor (preferably two hours after the Iftar meal). Going to Taraweeh Prayers can also be considered as part of your daily exercise regime during Ramadan. In poorly controlled type 1 diabetes, exercise may lead to severe hyperglycemia.

Al-Arouj M et al. Recommendations for Management of Diabetes During Ramadan. Diabetes Care. 2010 Aug; 33(8): 1895–1902. Doi: 10.2337/dc10-0896
Dietary recommendations for the month of Ramadan. World Health Organisation 2020, Apr 24 (online).
Guidelines for people with diabetes. International Diabetes Federation 2020, Apr 16 (online).
Mahmoud I et al. Recommendations for management of diabetes during Ramadan: update 2015. BMJ Open Diabetes Research and Care 2015; 3. Doi: http://dx.doi.org/10.1136/bmjdrc-2015-000108

About the Author
Celine Bjercke is a Dietician and Head of Coaching Engagement for GluCare.

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