Fasting, according to the religious law of Islam, means abstaining from eating, drinking, sexual intercourse between husband and wife, and speaking idly, as well as actions that conflict with morality, from dawn until sunset, with the intention (niyyah) for Allah alone.
Therefore, Muslim diabetic patients will adjust their eating habits by changing from 3 meals per day to 2 meals: the evening meal (Iftar, after sunset) and the meal before dawn (Suhoor).
Muslim diabetic patients who wish to fast should get a health check with a diabetes specialist before fasting to assess their ability to fast. This is because Muslim diabetic patients need to change their medication dosing schedules and reduce their meals to 2. Patients who take medication 3 times a day need to reduce it to 2 times a day according to meal times.
Diabetic patients at high risk and not recommended to fast include those with type 1 diabetes, pregnant diabetic patients, type 2 diabetes patients with poor blood sugar control or taking multiple insulin injections daily, those with severe diabetic complications, those with a history of frequent low blood sugar levels, those with kidney failure, etc. If such high-risk diabetic patients wish to fast, they must strictly follow the doctor’s advice and be ready to stop fasting at any time when advised by a doctor, or it may lead to health risks.
Guidelines for Diabetic Patients While Fasting
- Self-monitoring of blood sugar levels is important for self-care to avoid excessively high or low blood sugar levels. High-risk individuals are advised to test several times a day. They should check their blood sugar levels whenever they feel unwell or suspect high or low blood sugar levels.
- For food, drink, and exercise, avoid foods high in starch, carbohydrates, and fat, especially at Iftar, when foods with complex carbohydrates (Complex Carbohydrate) should be consumed, and have the pre-dawn meal (Suhoor) as late as possible to minimize fasting duration. Avoid sweets or foods high in sugar, sugary drinks, and caffeinated beverages. Stay well-hydrated after sunset. Avoid strenuous activities or heavy exercise during fasting, especially before sunset.
- Medication adjustment during fasting should be planned collaboratively between the treating doctor and the diabetic patient. The doctor will consider the type of diabetes, as well as the type and dosage of medication each patient uses, and adjust accordingly to the changed meal times during fasting.
Diabetic Patients Should Immediately Break Their Fast in the Following Cases
- Low blood sugar levels, less than 70 mg/dL: Follow the protocol for low blood sugar correction by drinking half a glass of fruit juice or 2 pieces of sweet candy and retest blood sugar after 15 minutes.
- High blood sugar levels, more than 300 mg/dL, or in the case of acute illness: Seek medical attention immediately.
Nurse Lakkhana Tetsapian
Diabetes Coordinator, Bangkok Hospital Chiang Mai
