Recommends type 1 diabetes patients to refrain from fasting
“Patients with type 1 diabetes should avoid fasting. However, those type 2 diabetes can fast,” said Dr KK Aggarwal, President, Heart Care Foundation of India and Secretary General, Indian Medical Association (IMA).
All diabetic patients who fast should be aware of certain facts if they fast during Ramzan, he further added.
All patients with diabetes should consult with their family physician regarding the Ramzan fast and learn the warning symptoms. Type 2 diabetes will be controlled by diet and may require no special precautions.
Patients at risk of diabetes should avoid overeating to prevent post meal high blood pressure, after the predawn and/or sunset meal.
The exercise programme for patients with diabetes on diet control should be modified to avoid lower blood sugar level. Exercise should be done 2 hours after the sunset meal.
Food restriction and dehydration may cause some cardiac risk in the elderly.
The choice of drugs in diabetes may require consultation with a doctor. Drugs that act by increasing the production of insulin are to be preferred. Some patients on metformin may fast safely with minimal complications. However, two-thirds of the total daily dose should be given just before the sunset meal and rest one-third before the predawn meal. Patients on pioglitazone may require no change in dose. Patients on sulfonylureas may require medical clearance before commencing fast.
Insulin dose also needs to be modified during the fast. Usually two doses of insulin, one before each meal, are sufficient.
If the blood sugar falls below 60, then the fast should be immediately broken.
Fast should also be broken if blood sugar rises to more than 300.
Patients should avoid fasting on sick days.