Patients with diabetes who observe the practice of fasting during the Muslim month of Ramadan, must know when to break the fast, should symptoms such as shaking, tremor, sweating, anxious, dizziness, hunger, palpitation, impaired vision, fatigue, weakness, headache, poor concentration and irritability occur. They should be alert towards these symptoms as these are the symptoms of a hypoglycemic attack.

They are advised to constantly self-monitor their blood glucose levels at home. If the blood glucose level falls below 3.5 mmol/l, they should stop the fast immediately. On the other hand, if they suffer from hyperglycemia (blood glucose level more than 16 mmol/l), they should also break fast without delay.

The meals during Ramadan should consist of a balanced and healthy diet. It should aim at maintaining a constant body mass. According to research, 50-60% of patients who fast maintain their body weight during the month, while 20-25% either gain or lose weight. Occasionally, the weight loss may be excessive (more than 3 kg). It is not advisable to consume large amounts of food rich in carbohydrate and fat, especially at the sunset meal. Predawn meal may include food containing “complex” carbohydrate, while foods with more simple carbohydrates may be more appropriate at the sunset meal. Such allocation is made in view of the delay in digestion and absorption.

Excessive physical activity may lead to higher risk of hypoglycemia and should be avoided, particularly during the few hours before breaking the fast. However, normal level of physical activities may still be carried out. If Tarawaih prayer (multiple prayers after the sunset meal) is performed, then it should be considered a part of the daily exercise program. In certain patients with poorly controlled type 1 diabetes, exercise may lead to severe hyperglycemia.

Clearly there are many issues to be addressed with regards to patients on the management of diabetes during the Ramadan month. When patients fail to adhere to the oral hypoglycemic agent or insulin regime in the past 11 months, chances are they may be at risk to develop complications of diabetes if they insist to fast.

Diabetes is more than just high blood glucose but it is a complex metabolic disorder affecting multiple organs and small vessels as well. Drugs and Insulin are just part of the management of diabetes as it requires much self-discipline and lifestyle modification for the better control of blood glucose.

Patients and healthcare providers should look beyond the numbers that appear on the glucometer and associate these numbers with the co-morbid conditions (like heart diseases, renal insufficiency, stroke) to stratify the risk of diabetes associated complications.

Management of diabetes also call for support from patients and family members, as doctors and healthcare providers are not able to make much difference if there is no co-operation from all parties as a team. For that matter, there are many NGOs that have been set up to help diabetic patients support each other and share their knowledge and experience on living with diabetes.

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