Fasting may not be part of our daily routine, but it is something that many people practise.
Especially if you have diabetes, it is vital to plan your meals well when you fast. This is because you don’t want to risk having low or high blood sugar levels which can affect your health which could also put your life at risk.
We speak to Zaifa Khatum Bt. Abdul Mohamed Ibnu, a Diabetes Nurse Educator from Sunway Medical Centre to understand more about fasting for diabetic patients.
1Twenty80: What should a diabetic take note of when fasting?
Zaifa Khatum Bt. Abdul Mohamed Ibnu:
First and foremost, patients must have a well-controlled sugar level before they start fasting. If their sugar level is high before fasting, there’s a high risk that they’ll become dehydrated.
A good glycaemic control (sugar level) in the morning before they start fasting should be between 4.4 to 7.0 mmol/L and two hours after a meal, the patient’s sugar level must be between 4.4 to 8.5 mmol/L. Patients can safely fast when their sugar level is in between the mentioned range.
Certain patients who have complications with their kidneys, injecting insulins with poor control over their sugar level or other complications may not be a suitable candidate to fast.
1Twenty80: What happens to the body during fasting?
Zaifa:
Usually diabetics assume that if they don’t eat, then it isn’t necessary for them to take their medication. Patients fail to understand that by not eating their meal and medications on time, their sugar level can rise up as well as drop below average level. However, it’s also based on the individual’s food and medication regimen. It varies between each individual.
Nevertheless, if a patient fasts for too long, their sugar level can increase. It is not due to the food but from their own liver and muscle storage that increases the sugar in their body to give them the energy they need.
Quotes: First and foremost, patients must have a well-controlled sugar level before they start fasting. if their sugar level is high before fasting, there’s a high risk that they’ll become dehydrated.
1Twenty80: Can diabetic patients fast without consent from their doctor?
Zaifa:
Patients definitely need to get consent from their doctor before they start fasting. The doctor will help to change the patient’s regime that will be suited for fasting and it may not be the same as before. The doctor may either increase or decrease the medication dosage to suit the patient’s needs when they’re fasting.
Doctors or other healthcare professionals will advise patients to practice fasting for at least three to seven days before their actual fast begins. This is done to monitor their sugar level and body condition when they fast. If the patient’s sugar level is steady, they can proceed with fasting. However, if patient’s sugar level is not stable, then doctors will advise them not to fast as it may worsen their condition.
1Twenty80: Will there be an increase in symptomatic hyperglycaemia and hypoglycaemia in diabetic patients while fasting regularly?
Zaifa:
There can be an increase or decrease in both hyperglycemia (high sugar level) and hypoglycaemia (low sugar level) if patients do not have proper medication that is suitable for them during the fasting period.
1Twenty80: What is your dietary advice during the fasting period? what should the eating pattern be?
Zaifa:
Generally, some people may not want to eat during sahur (morning break) which will cause their fasting period to be longer.
Patients are advised to take their sahur meal. If patients do not, they are actually fasting for a longer period of time. This will cause their sugar level to increase or decrease within time. However, it may differ among individuals and it still depends on their eating and medication pattern.
The meal should have more fiber, brown rice or wholemeal as it last longer in the body and that helps to keep their blood sugar balanced at any time of the day especially during the fasting period.
1Twenty80: What are the warning signs to look out for that they might need to put a stop to fasting?
Zaifa:
Perhaps the most important part of fasting is knowing when to quit. A general guideline to break the fast is when patients encounter symptoms such as hand and body trembles, lightheadedness, dehydration and feeling weak. Apart from that, their sugar level should not be less than 4 mmol or above 15 mmol.
Frequent monitoring will help to reduce the risk of both hypoglycemia (low sugar level) and hyperglycemia (high sugar level).
1Twenty80: What is the right method to breaking fast?
Zaifa:
The right method is to start with one or two kurma fruits and a glass of water. If the kurma fruit is very sticky, it is usually immersed with sugary substances. Therefore, it is advisable for patients to take one or two pieces only.
Also, I advise my patients to take their medication only when they’re about to eat a heavy meal or else, their sugar level will drop and they’ll feel weak and dizzy.
On the other hand, after breaking fast, patients can have some snacks, but it should not be anything sweet or snacks that contain high amounts of carbohydrate.
1Twenty80: What would your advice be regarding fasting for diabetics?
Zaifa:
In my opinion, it’s important for patients to visit their doctor a month before they start their fasting. They could also have a talk with a diabetic educator or a dietitian as we do have fasting guidelines for diabetic patients. Talking to a health professional will also guide patients about making the right food choices, time for eating their meals and medications.
Quote: A general guideline to break the fast is when patients encounter symptoms such as hand and body trembles, lightheadedness, dehydration and feeling weak.
