Dr. Mohamad Milad is an Internal Medicine specialist in the Diabetes Clinic at Al Khor Hospital (AKH), which is one of Hamad Medical Corporation's hospitals. He was asked to elaborate on whether diabetic patients can fast.
The body of a fasting person normally manages to obtain necessary energy through metabolism of stored carbohydrates, fats and proteins. This leads to an increase in the ketone bodies, which are chemicals the body produces when there is not enough insulin in the blood and it must break down fat instead of the sugar glucose for energy. The healthy body can easily dispose of these ketone bodies, which are toxic acidic chemicals, usually without any negative effects simply through urine discharge. However, for diabetic persons, the metabolization of carbohydrates, fats and proteins is not an efficient process and this may lead to dangerously highly level of ketonic acids accumulating in the body. Particularly in case of insulin dependant diabetics who need to take regular insulin, the level of toxins can increase too high if they fast. Non-insulin dependant diabetics, however, may find fasting of great benefit, as the fat burning process associated with fasting will keep their body healthier.
Dr. Milad explained: "Diabetics should seek qualified medical advice before fasting. Patients with type 1 diabetes (insulin dependant diabetes) who suffer recurrent attacks of hyperglycemia or hypoglycemia, diabetics who use insulin pump, diabetics who need three or more doses of insulin each day, and diabetics who have experienced diabetic ketoacidosis (DKA) within the last three month (DKA results from dehydration during a state of relative insulin deficiency, associated with high blood levels of sugar level and organic acids called ketones) should probably not fast – especially where a diabetic live alone and might suffer a hypoglycemic attack without anyone to help in a life-threatening situation. Diabetics with severe diabetic retinopathy, diabetic nephropathy, stroke, or coronary thrombosis are adviced to avoid fasting, in addition to a pregnant or lactating diabetic". Dr. Milad added that patients with type 1 diabetes with controlled blood sugar level (where HbA1C is less than 7%), who haven't suffered diabetic ketoacidosis (DKA) or recurrent attacks of hypoglycemia during the last 3 months may be able to fast, but should so with great care.
Furthermore, Dr. Milad outlined that patients with type 2 diabetes who sustain some health complications are advised not to fast. These include patients with diabetic nephropathy associated with high creatinine, severe diabetic retinopathy, hypoglycemic unawareness, stroke or coronary thrombosis, in addition to type 2 diabetics who take more than two doses of insulin a day, have sustained high levels of blood sugar during last few weeks before Ramadan, and any pregnant or lactating type 2 diabetics. He added that a diabetic suffering another disease such as severe gastric ulcer, nephrolith or cancer is advised to avoid fasting.
"Fasting diabetics should not skip the Sahour meal or do physical exercises during the daytime as that may cause a significant drop in sugar levels. They are also advised to take their medications, whether insulin or tablets, directly after sunset. When a diabetic feels signs of low blood sugar he should immediately take a glass of juice, liquid solution or two spoonfuls of honey, and then take a meal."
"Never try to continue fasting while you feel your blood sugar drop significantly," said Dr. Miad, adding that blood sugar should be tested tree times a day also during Ramadan, using a home blood glucose monitor; two hours after Sahour meal, one hour before Iftar meal to detect any drop in the blood sugar level and two hours after the Iftar meal to check whether there is any rise in the blood sugar level.
Dr. Milad highlighted the prevalence of diabetes and related health complications in the Gulf region, referring to a study conducted in the UAE on diabetics with signs of renal complications. The study showed that 61% of patients are discovered to have albumin in urine, which is a real indication of deterioration in the health condition of the kidneys.