Diabetes & Fasting
Is It Possible to Fast for Patients with Diabetes?
In order to answer this question, we need to know which patients with diabetes are issued, the medications they take, whether the blood glucose balance is provided or not, and other diseases, if any.
There is a saying in medicine that “there is no disease, there is a patient”. Just as the conditions and medications of patients with the same disease may be different, the answer to this question may vary from person to person. Generally, fasting can be more difficult for a patient with diabetes and more complicated than a healthy individual.
For this reason, patients with diabetes should consult their physician before the decision to fast. Our patients will fast anyway because they think that their doctor would say “do not fast” somehow. However, we allow some patients with diabetes to fast. In fact, we support our patients who want to fast but we do not allow, at least so that they can fast more easily and suffer less.
As it is known, we recommend snacks as well as main meals in the diet of patients with diabetes. In other words, we ensure that food is taken in several meal. In this way, we can avoid the high blood glucose due to excessive food intake after the main meals. In addition, we also prevent the low blood glucose depending on the medication and insulin taken.
Moreover, we recommend patients with diabetes to consume plenty of water. In such patients, dehydration occurs due to the excretion of glucose from the urine, especially due to high blood glucose. For this reason, patients with diabetes complain about frequent urination, excessive water consumption and dry mouth, especially when their blood glucose is irregularly high.
However, it is possible for many patients with diabetes to fast. For example, there is no harm only for patients with insulin resistance or prediabetes to fast.
Likewise, patients with type 2 diabetes but use only glucose stabilizer medications in addition to diet, but not use glucose-lowering medications or insulin yet are allowed to fast. However, even such patients need to be supervised by a physician. Since some patients with diabetes may also have low blood glucose. These patients must continue to monitor their glucose level and diet program during Ramadan.
However, patients with Type 1 diabetes (usually insulin-dependent diabetes that occurs at a young age) or patients with Type 2 diabetes but using multiple doses of insulin should never fast. Without considering what type of diabetes they have and which medication they take, patients with diabetes having difficulty in controlling glucose and experiencing hypoglycemia and hyperglycemia should not fast.
Some patients with diabetes do not involve either of these groups. These type of patients with diabetes is controlled with glucose-lowering pills or insulins that are applied once a day, which we call 'basal', and continue their effect all day. It is not recommended for such patients to fast. However, if these patients insist on fasting, they must fast according to their physicians’ consultation and under their supervision.
Who is never recommended to fast?
- Patients whose blood glucose often decreases below normal (below 60-70 mg/dl),
- Patients unaware of hypoglycemia,
- Patients whose blood glucose is irregular or poorly regulated,
- Patients with renal, heart or liver failure,
- Pregnants
- Patients with diabetes living alone (especially the elderly ones),
- Patients with diabetes having diuretic treatment for various reasons,
- Patients having multiple-dose insulin therapy
What are possible troublesome situations that patients with diabetes may encounter during fasting?
Hypoglycemia can be seen more especially in patients using insulin and taking glucose-lowering medications. Taking too much food to prevent this conversely causes high glucose.
The glucose storage in the body is sufficient for a period of approx. 8-hour hunger. Afterwards, our body tries to provide energy by burning fat. In this case (especially in the absence of insulin hormone), some toxic substances accumulate in the blood.
Moreover, when blood glucose is high above 180 mg/dl, it begins to be excreted with urine. In this case, frequent urination happens. As a result, abnormal dehydration arises. This can result in low blood pressure, deterioration in salt balance, imbalance and syncope.
As a result of high blood glucose and dehydration, the risk of blood clotting increases. This can lead to undesirable situations.
What is recommended to prevent hypoglycemia attacks?
What are practical suggestions for fasting patients with diabetes?
- With the help of a physician and dietitian, an up-to-date diet should be scheduled according to the daily calories we need in Ramadan.
- The schedule of the medications should be regulated by the physician so that they are taken between iftar and sahur period. If necessary, the doses of some medications can be changed, or even some drugs can be added or removed from the schedule.
- Instead of overeating in iftar and sahur time, it is more convenient to eat frequently and less in the period between them.
- It is quite important to drink plenty of water between iftar and sahur period.
- Bread, flat bread, pastries, rice, potatoes and sweet foods should be restricted in accordance with the dietitian's recommendation.
- Foods containing protein and fat provide satiety for a longer time. On the contrary, excessive protein consumption can both make you thirstier and impair renal functions. Protein-containing foods (milk, low-salt cheese, yoghurt, eggs, chicken, legumes) that can keep blood glucose balanced for a longer period of time should be consumed with the recommendation of a dietitian.
- Soup, vegetable dishes and dishes with olive oil should be preferred.
- Exercising excessively is not recommended for patients with diabetes during fasting, as it can lead to dehydration through sweating and decreased glucose. Walking in the period between iftar and sahur will be beneficial for digestion.
- It is recommended to avoid the sun during the hot hours of the day and to choose comfortable and sweat-free clothes.
How should the patients take their medications?
If patients with diabetes insists on fasting, they should consult their physicians and the treatment schedule should be rearranged for Ramadan. Drugs that lower insulin resistance or only regulate blood glucose may not usually require dose adjustment. On the other hand, the doses and application times of glucose-lowering medication and insulins need to be arranged again. Otherwise, hypoglycemia may occur.
What is recommended for patients with accompanying disorders such as renal failure and heart failure due to diabetes?
Patients with heart or renal failure should never fast, regardless how well they are in terms of diabetes and how little medication they take. Because these patients can suffer very serious water/salt balance disorders and changes in blood pressure level with long-term thirst and hunger. Thirst, changes in water and salt balance can affect patients with heart and renal disease more negatively and even pose life risks.