Diabetes is a disease that is quite common in our society and can progress with serious complications. Diabetic patients have requests and questions about fasting in Ramadan, which is one of our religious obligations. This subject is actually a very complex subject. Each patient should be evaluated individually. Istanbul Okan University Hospital Endocrinology and Metabolic Diseases Specialist Assoc. Dr. Yusuf Aydın talked about general principles regarding fasting of diabetic patients.
Type 1 diabetes patients need to use insulin lifelong. These insulins are generally 3 or 4 doses per day. Some Type 1 diabetes patients also try to control their blood sugar with the insulin pump. Therefore, it is not possible for these patients to fast. If they do not produce insulin for a short period of time, they may enter into high sugar (hyperglycemia) and ketoacidosis coma. Therefore, these patients should never attempt to fast.
Life-threatening consequences can occur in patients with type 2 diabetes who are fasting!
Our patients with type 2 diabetes, on the other hand, receive treatment in very different groups. Therefore, each patient should be evaluated individually. Basically, hypoglycemia, ie low sugar and hyperglycemia, treatment planning should be done in a way that does not cause high sugar. If this clinical condition develops in diabetic patients fasting, life-threatening results may occur.
First group and second group type 2 diabetes patients can fast by adjusting the drug doses!
First group of patients; Type 2 diabetes patients who use very low doses of medication and have their blood sugar under control and do not have any additional diseases. These patients can fast by adjusting the drug doses. Most of these patients use one or two sugar pills. The treatment can be changed by shifting the sulfonylurea group (glibenclamide, gliclazide, glimeprid) drugs that cause hypoglycemia to iftar. If he only uses metformin and his blood sugar is regular, there will be no harm in fasting.
The second group of patients is those who use a single dose of insulin and glucose-lowering drugs. In these patients, insulin is administered immediately after iftar, and drugs that do not cause hypoglycemia in sahur can be added to the treatment and fasting can be achieved. Since these patients use insulin, close monitoring of blood glucose should be done in terms of hypoglycemia risk. Especially these people should be closely monitored for hypoglycemia after 15-16 o'clock in the afternoon. If blood sugar falls below 70 mg / dl, he should bring his blood sugar to normal by breaking his fast.
Fasting is Not Appropriate for Third Group and Fourth Group Patients with Type 2 Diabetes!
The third group of Type 2 diabetes patients are those who use two or more insulin treatments. Fasting is not appropriate in this patient group, as fasting may worsen blood sugar regulation and lead to hypoglycemia, just as in Type 1 diabetes patients.
The fourth group of Type 2 diabetic patients, on the other hand, are the patients whose blood sugar levels are very volatile and have serious complications. For example, it is not very suitable for patients with bypass or stent history, uncontrolled hypertension, severe diabetes eye diseases, and recent stroke, even if their blood sugar is good. Because in the case of hypoglycemia or hyperglycemia, life-threatening consequences may occur.
Assoc. Dr. Yusuf Aydın said, “The groups should be evaluated as a general recommendation. Every diabetic who wants to fast should consult their physicians before Ramadan to evaluate the general condition of their blood sugar and the latest condition of their comorbidities. Especially if the HbA1c value, that is, the 3-month blood sugar average, is above 8,5%, this patient's blood sugar control should be considered as bad. I think it is not appropriate for these diabetic patients to fast, '' he said.
Patients who plan to fast and whose physicians allow it, should definitely do sahur during Ramadan when they are going to fast. In suhoor, it is necessary to consume foods with high protein content (eggs, cheese, legumes and protein soups). In addition, people who fast in hot regions have a high risk of fluid loss, so they should take sufficient water and liquid foods in sahur. In addition, it is absolutely necessary to monitor their blood sugar closely and more closely during the fasting period.
I recommend that our patients who plan to perform fasting should definitely meet with their physicians before Ramadan and have their clinical situation assessed. As a result, as I mentioned before, every patient can fast according to his / her special condition, if the physician allows it.