After my six years of practice in Diabetes management in the valley, I can tell you all that there are only two things that are in abundance in Kashmiras of the current moment. One, Kashmiri apples, and two, Kashmiri diabetics. Sounds amusing, but it is actually a bitter truth. Diabetes is the Nipah virus of the valley, spreading at such an alarming rate that sometimes the treating doctors feel it is a communicable disease.
On top of that is the abundance of myths and misconceptions that envelope the disease and its management that make a proper treatment for this disease a challenging task in the long run. Many achieve good blood sugar control after proper diet and medication regime devised by the treating Endocrinologist, diabetologist or the physician but then comes along some relative or a family friend who suggests a new diet, a new way to take fruits or a new place for the patient to be where patient gets better just by drinking some herbal potion for a few days.
Treating diabetes and its advise comes from all the members sitting in a drawing room where the prescription is dissected by well-wishers who in reality mean good for the patient but have no background in medicine, and then comments are passed on whether the patient should be taking insulin or why the patient is taking three drugs to maintain sugars whereas the persons mother or aunt is better with just one tablet and no insulin. The end result of the above is the diversion of patient from his actual medication and loss of good control that both the patient and his doctor worked so hard to achieve. It is important to realize that every diabetic is different and so is the stage of his diabetes and the power left in his pancreas, and after some time only anti diabetics either as tablets or insulin or both will be needed and no amount of diet alone or just some fancy supplements the patients grand child got from Saudi or the US will work to control sugars.
Another time when a lot of confusion and misconceptions arise in diabetes management is the arrival of the holy month of Ramadan when many patients suffering from diabetes do not know whether they can keep the fast or not, and if they can, whether it will be good for them or not.
Well, my take on the above paradox has evolved after examining the pros and cons of fasting in Ramadan and I can state with confidence that Ramadan is for every one of the Muslim faith including the Diabetic patients, but with a lot of scientific thought behind it, a concept created in such a way that even a seven year old child can keep it.
Thus a well informed and prepared diabetic patient can surely fast if his diabetes is not very complicated by a kidney or heart disease and if he does not forget at the time of Sehri and Ifta that despite being hungry for twelve hours that he is a diabetic and now has to take diabetic foods to start and break his fast. Those who may argue against keeping fast in Ramadan may not realize that many diabetics lose control on sugars despite not fasting as they eat their normal diet plus also share the abundance of fruits and dates in the evening along with other family members who kept the fast and thus end up having six to seven meals a day. A diabetic who keeps fast actually ends up having only two to three meals a day in Ramadan and thus the chance of glycemic control loss does not arise as long as the patient takes low calorie and low glycemic foods.
One advantage that is also seen in diabetics who keep fast is the reduction in body mass index for many patients and the mild loss of weight that is seen, plus many smoker diabetics also partially or completely refrain from smoking in Ramadan thus the effects are seen on their vital capacity of the lungs and their energy levels. Since smoking in diabetes wreaks havoc on the blood vessels due to the combined effect of sugars and smoking. Many smokers in fact end up quitting for good and that is reason enough to encourage the motivated and suitable diabetic to keep fast.
Among the females suffering from diabetes a proportion of them suffers from chronic lack of energy, a form of low grade fatigue syndrome throughout the year which is not the case in Ramadan where they become actively involved in getting up early, preparing meals for the family and praying many times a day, a regimen that seems to do well for them. This is evident from the fact that the vague pains of the diabetic patient that keeps them going to orthopedicians disappears during this period.
Thus fasting according to me is the perfect time for a diabetic to discipline himself or herself and leave all the bad habits behind. Some exceptions to fasting are patients with severe kidney disease, recurrent hypoglycemia, that is low sugars and severe cardiac or diabetic eye disease where prolonged fasting may lead to some effects.
Despite describing so many benefits of Ramadhan, many diabetics end up losing blood sugar control post Ramadan. In fact a storm of new onset diabetics comes running to hospitals at the end of the month. The agent behind the above seems not to be the fasting 30 days but the 3 days of Eid that follow. Diabetes, the deadly disease that is afraid of Ramadan finally gets to win when all control over diet is lost on the day of Eid and the few days that follow. Even the strict and disciplined family members who take care of the diet of the diabetic family member turn a blind eye for a few days to the feasting that is done and sometimes even force the diabetic guest at their house if any to take that extra rice and that sweet Phirni and sweets from the famous Mithaiwalas from Srinagar and Jammu.
The author of the article is a consultant diabetologist in Florence hospital Chanapora .