Diabetes in the Holy Month of Ramadan Dr. M.K. Abedi
Why are we here today? • Islam is the second largest religion in the London Borough of Enfield. • Diabetes is most common amongst Asian patients. • This year Ramadan is expected to begin on 28th June 2014 at thesighting of the new moon • Ramadan will end on 28th July 2014
Diabetes and Ramadan • Diabetes is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use what we eat properly. • During the Holy Month of Ramadan people change their eating habits. This may affect blood glucose levels in a way that can make some people feel very unwell. • We are here to give you information on how to stay well.
Fasting in 2014 • This year you will be fasting for up to 19 hours • July may also be very hot • Peak temperature in London is 300 C ( 900 F) • Average temperature in London is 220 C (700 F)
If you have diabetes • You need to make an appointment to see your General Practitioner or Practice Nurse • What needs to be considered: • What treatment are you on? • Has your health been generally good in the last year? • Are your blood glucose levels generally well controlled? • Do you have diabetes complications? • How have you managed during Ramadan before and how have you felt?
If you have diabetes who should not fast? • If you have recently been diagnosed • If you have Type 1 or Type 2 diabetes that is not well controlled • If you have hypo unawareness • If you are elderly or frail • If you have a history of diabetic ketoacidosis • If you have been having recurrent infections • If you have kidney problems • If you have had problems fasting before • If you have unstable epilepsy
What are the risks of fasting for Ramadan if you have diabetes? • Hypoglycaemia • Low blood glucose levels • Hyperglycaemia • High blood glucose levels • Dehydration • Lack of fluid in the body
These vary from person to person Confusion Dizziness Drowsiness Headache Hunger Fast heart rate Sweating Weakness Feeling jittery Irritability Symptoms of Hypoglycaemia orLow blood sugar
Causes of hypoglycaemia • If you take insulin, you may have taken too much • Lumpy injection sites • You may have reduced the amount of carbohydrate in your diet • You may have delayed or missed a meal • Increased stress levels • Increased your physical activity • Hot weather can affect some people • Some drugs can cause hypoglycaemia
Treatment for hypoglycaemia • Check blood glucose level if possible • Eat or drink something sweet • Lucozade 50 – 100 mls • Or Coke 50 – 100 mls (NOT DIET COKE) • Or 3 – 6 glucose tablets • Repeat if symptoms are not resolved after 5 – 10 minutes • When feeling less unwell, eat your next meal or have a snack like a sandwich or a banana • If you are getting episodes of hypoglycaemia you will need to visit your GP
Symptoms of hyperglycaemia or high blood sugar • Weight loss • Increased thirst and dry mouth • Tiredness • Blurred vision • Headache • Loss of concentration • Frequent urination
Causes of hyperglycaemia • You have stopped your medication • You are taking the wrong dosage of your medication • You have reduced the amount of activity that you do • You have changed your diet
Treatment for hyperglycaemia • Take correct dosage of medication at the correct time • Take regular physical exercise • Avoid changes to healthy eating plan • See your GP if symptoms persist
General precautions for Ramadan • Plan your meals carefully • Do not skip meals • Avoid over eating at Iftar or Sehri • Continue to take your medicines as prescribed by your doctor • If Type 1 diabetes check for ketones if blood glucose level is high (>14 mmols) • Drink plenty of sugar free drinks • Know who to contact if in an emergency
Your Diet • If breaking fast with dates and milk, if diabetes is present dates should be limited to a maximum of 3 • Limit or avoid sweets and fried foods at the start and break of your fast • Try to fit in 5 portions of fruit and vegetables a day • Fill up on starchy foods like rice, chappati, couscous, wholegrain bread • Eat foods higher in fibre as these are more filling and can prevent constipation • Drink lots of fluids before fasting commences
Medication • There are leaflets available today that will give you further guidance about your medications for diabetes and how fasting may affect how they work • If you are concerned about your tablets, contact your GP or Practice Nurse.
Other possible health problems during Ramadan • Headache: • Try to eat foods that have a slower absorption rate e.g. grains and pulses. • Constipation: • Drink plenty of fluids and eat foods that are high in fiber. • Indigestion: • Reduce fried foods and eat smaller portions at a time.