By: Thalia Kaylyn Averil
Diabetes mellitus is a metabolic disease characterized by high blood sugar levels. The pancreas has a cluster of cells called the Islets of Langerhans. The Islets of Langerhans consist of two main types of cells, alpha cells that produce glucagon and beta cells that produce insulin. Insulin functions to lower blood sugar levels, while glucagon functions to increase blood sugar levels. These cells will adjust the amount of hormone released based on the blood sugar levels in the body. Abnormal blood sugar levels can occur if there is an imbalance between insulin and glucagon.
The two main subtypes of diabetes mellitus are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). In type 1 diabetes mellitus, the body’s immune system attacks and destroys beta cells in the pancreas which play a role in producing insulin. This causes insulin production to be very little or nonexistent. In type 2 diabetes mellitus, insulin is still produced, but the body becomes less sensitive to the effects of insulin or resistant to insulin. Insulin resistance is often associated with obesity, aging, and other factors. Type 1 diabetes mellitus often occurs in children or adolescents, while type 2 diabetes mellitus commonly affects adults or the elderly who experience prolonged hyperglycemia due to poor lifestyle and dietary habits.
Diabetes mellitus can affect many organs, putting patients at risk of various complications during fasting, such as dehydration, hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), and diabetic ketoacidosis (DKA).However, fasting can be beneficial for patients with type 1 and type 2 diabetes mellitus if done properly, especially with guidance from healthcare professionals. Fasting can reduce the risk of hypoglycemia in type 1 diabetes mellitus patients, stabilize blood sugar levels, and increase fat metabolism in type 1 and type 2 diabetes mellitus patients. Fasting can also make the body more sensitive to insulin, reduce the amount of glucose produced by the body, helping reduce weight, and improve body composition.
Here are some tips that can be followed during fasting for patients with diabetes mellitus:
- Consult with a healthcare professional
Before fasting, it is important to consult with a healthcare professional to ensure your body’s condition and adjust your diet and medication.
- Don’t skip sahur and eat healthy food during sahur
Eating during the pre-dawn meal (sahur) is important before starting the fast to ensure that the energy needs for daily activities are met. Foods high in fiber, such as cereals, oats, whole grains, or brown rice, are digested more slowly by the digestive system. This can help you feel full for longer and they also have a lower glycemic index. Additionally, you should also pay attention to the portion sizes of carbohydrate-containing foods. Green beans and lentils are good sources of protein and high in fiber; combining them with fruits and vegetables can prevent constipation. Drinking an adequate amount of sugar-free and caffeine-free fluids is also important before fasting to prevent dehydration during the day.
- Check blood sugar levels during fasting
Patients with diabetes mellitus have a higher risk of hypoglycemia during fasting, especially if they are taking medications such as insulin. Therefore, it is important to check your blood sugar levels more frequently and recognize the signs of low blood sugar, such as disorientation, watery eyes, sweating, irritability, blurred vision, and trembling. If your blood sugar falls below 70 mg/dl, you should break the fast by eating or drinking immediately to avoid other complications. High blood sugar levels can occur if you do not take regular medication, eat large portions of sweet or starchy foods, or become less active than usual during fasting. High blood sugar can increase the risk of dehydration, causing dizziness and fatigue. If you experience blood sugar levels above >300 mg/dL during fasting, you should drink water and consult with a healthcare professional to prevent diabetic ketoacidosis (DKA). Therefore, it is important to bring food and drink with you in case your blood sugar levels increase or decrease.
- Break the fast with healthy food
You can break your fast by drinking mineral water and appetizers such as dates. Dates, a food that is often consumed when breaking the fast, are a food that is high in fiber, but also rich in carbohydrates. Two large dates contain about 20 grams of carbohydrates, which is equivalent to a medium-sized slice of bread. Therefore, limiting the number of dates consumed when breaking the fast is highly recommended. Apart from that, consumption of sweet snacks also needs to be limited because small amounts can increase your blood sugar levels significantly. Drinking mineral water or other sugar-free fluids is the best choice for rehydration because sugary drinks can make you thirstier. After the Maghrib prayer, you can consume a balanced main meal and fruits while paying attention to balanced nutrition.
- Eat and drink again after the Isha/Taraweeh prayer
To keep blood sugar stable, it is important to eat again after the Isha/Taraweeh prayer with diabetes-specific milk or about 100 grams of fruit and drink enough mineral water.
The following are tips for fasting for diabetes patients. It is important to remember that diabetes patients should consult with healthcare professionals before starting fasting.
Resources
- Sapra A, Bhandari P. Diabetes. [Updated 2023 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/
- Herz D, Haupt S, Zimmer RT, Wachsmuth NB, Schierbauer J, Zimmermann P, Voit T, Thurm U, Khoramipour K, Rilstone S, Moser O. Efficacy of Fasting in Type 1 and Type 2 Diabetes Mellitus: A Narrative Review. Nutrients. 2023 Aug 10;15(16):3525. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10459496/
- Diabetes UK. Diabetes dan Ramadan [Internet]. London: Diabetes UK; date of publication unknown [cited 2024 Mar 19]. Available from: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/ramadan
- Ganefi H. Tips puasa untuk penderita diabetes [Internet]. Jakarta: Direktorat Jenderal Pelayanan Kesehatan; 2023 Apr 4 [cited 2024 Mar 19]. Available from: https://yankes.kemkes.go.id/view_artikel/2294/tips-puasa-untuk-penderita-diabetes
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