The following patients having diabetes should not fast ( or else should seek an advice before fasting)
1) Patients whose blood sugar has anytime remained above 300mg or below 70 mg in the preceding three months.
2) Patients whose HBAiC his above 8.5%
3) Patients who require frequent insulin injections apart from morning and evening doses.
Diabetic patients who can fast:
1). Patients whose diabetes is controlled on diet and exercise alone
2) Patients whose diabetes is controlled on Metformin tablets
3 ) Patients who are controlled with other oral drugs. They should reduce the dose of medicine by 50% at sahri.
4) Patients who are controlled on single dose of night insulin should reduce the dose of insulin by 25%. For example, if a patient is controlled on a single dose of 20 units of insulin at night, he should take only 16 units of insulin. Tea should be avoided during Ramzan fasting by the diabetics as it leads to dehydration.
5) If a diabetic patients take morning dose of insulin also ( in addition to his evening dose) he should reduce the morning dose by 50% .For example, if a patient takes 20 units of insulin in the morning, he should take only 10 Units.
6) As already told if a patient takes insulin in the evening also, he should reduce evening dose by 25 % only( for 20 units he should take only 16 units)
7) If patient needs frequent regular insulin dosing during day (apart from morning and evening doses) such a patient should not fast.
8 ) A diabetic who is fasting should monitor blood glucose levels 2 hours after Sahri, at noon time, mid day to see what are the sugar levels. This is especially for those who are on insulin and other oral drugs apart from Metformin. If sugar level goes above 300 mg or is slipping down 70 mg, the patient should break his fast
9) Diabetic patient who is fasting should avoid strenuous exercise during fasting hours as it may lead to hypoglycemia( low sugar levels) which may prove dangerous
10). If a fasting diabetic patient feels sensation of dizziness, gets palpitations and sweating with a feeling of fainting, it could mean low blood sugar levels, he should immediately break the fast.
Remember, if the fasting blood sugar goes below 65 mg the patient should immediately break the fast even if Iftar time is just ten minutes away, otherwise it can prove disastrous.
God Bless all patients.
Dr. A. Wahid is Ex HoD Medicine, SKIMS, Srinagar