A few years ago CHC published a blog discussing Ramadan and the precautions diabetic patients may need to take to manage their health while fasting. Given that Ramadan occurs during the summer solstice this year, meaning the time between sunrise and sunset is significantly longer, we have updated the previous blog to reflect the potential challenges patients may face. CHC dietitian Marissa Garcia, MS, RD, CD-N has prepared a number of suggestions for diabetic patients to follow during Ramadan.

Fasting from dawn to sunset during the holy month of Ramadan is an important spiritual practice for many Muslim adults. Ramadan is based on the lunar calendar which means that the duration of fasting varies according to the time of year in which Ramadan falls. For the year 2016, Ramadan falls during the month of June and Muslims on the East coast of the United States will be fasting for over 17 hours a day. Although exemptions exist for people with medical conditions, such as diabetes, many adults follow this fast without seeking medical advice.

Change in lifestyle and eating patterns during Ramadan puts patients with diabetes at an increased risk for hypoglycemia (low blood sugar) during the day and hyperglycemia (high blood sugar) at night. Your healthcare provider may change the dosing, type, or timing of medication in order to minimize these risks.

There is a misconception held by some Muslim communities that checking your blood sugar breaks the Ramadan fast. Checking your blood sugar is an essential component of diabetes care, especially when used to identify low blood sugar. A fast will have to end if your blood glucose level falls too low (<70 mg/dL) or becomes too high (>300 mg/dL). Symptoms of hypoglycemia (low blood sugar) include trembling, sweating, chills, altered mental status, and headache whereas symptoms of hyperglycemia (high blood sugar) include extreme thirst, frequent urination, fatigue, and nausea/vomiting.

The fasting and feasting nature of Ramadan can encourage the consumption of large, carbohydrate-rich meals and sugary treats that can have a negative impact on blood sugar levels. In order to decrease risks of hyper- and hypoglycemia, strive to eat a good balance of complex carbohydrates (whole grain products and foods high in dietary fiber), protein, and fats at the Iftar and Suhoor meals. Aim to consume smaller portions of carbohydrate-rich foods and sugary treats in order to minimize the risk of hyperglycemia after the large meal. It is important that you consume an adequate amount of calories from each of the main food groups in order to prevent hypoglycemia during the fasting period. Adequate hydration, particularly in warmer months, is also essential. Drink plenty of water and non-sweetened beverages during permissible hours.