Diabetes Management During Ramadan
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DIABETES MANAGEMENT DURING RAMADAN Times to measure blood sugar throughout the day: 1. Before Suhoor (4 AM) 5. Before Iftar (sunset) (8 PM) 2. Morning (8 AM) 6. After Iftar (12 AM) 3. Mid-day (12 PM) 7. Anytime there are hypoglycemia/ 4. Mid-afternoon (4 PM) hyperglycemia symptoms or not feeling well Know when to break your fast: Go to the hospital emergency Blood sugar <70 mg/dl or hypoglycemia* symptoms, room if very ill: re-check within 1 hour if blood glucose 70-90 mg/dL Multiple episodes of vomiting (more than 2) If hyperglycemia with ketones in urine, or if Low blood glucose (below 150) after drinking sugary symptomatic.** It’s important to stay hydrated. beverages AND positive ketones (small, moderate or When feeling sick and experiencing cold/flu like large) symptoms. Abdominal pain *Symptoms of Hypoglycemia: Trembling, Sweating/chills, Breathing problems Palpitations, Hunger, Altered mentation or Confusion, Headache Unable to drink fluids and going to the bathroom less frequently or stops urinating – (signs of dehydra- **Symptoms of Hyperglycemia: Extreme thirst, Hunger, tion) Frequent Urination, Fatigue, Confusion, Nausea/Vomiting, Abdominal Pain Appears more sleepy or difficult to wake Patients with Type 1 diabetes (T1DM) who have any of the following conditions are strongly advised not to fast: History of recurrent hypoglycemia Hypoglycemia unawareness Poor diabetes control Uncontrolled blood sugars Non-compliance with medical treatment Unable to regularly monitor and manage their blood glucose levels 1 Dietary Recommendations Exercise Recommendations Advise to eat fiber rich, low-glycemic index carbs (e.g. A reasonable level of physical activity should be fruits, vegetables, whole grains, beans, nuts, and dairy). maintained during Ramadan, with consideration to avoid strenuous exercise in the hours before Iftar when Limit intake or serve a smaller portion of traditional hypoglycemia is most likely. desserts and high glycemic index carbs (e.g. white bread, white rice, low-fiber cereal, white potatoes) Sugary drinks, syrups, and canned/fresh juice with added sugar should be avoided. Choose lean protein sources, like fish, skinless poultry, diary products, nuts, seeds, and beans. Minimize intake of high saturated fat foods (beef, lamb, butter, ghee, cream, processed meat, fried food) Incorporate more monounsaturated and polyunsaturated fats (e.g. avocado, extra virgin olive oil, vegetable oil, fish, olives, nuts and seeds). Accurate carbohydrate counting at pre-dawn (Suhoor) and sunset (Iftar) meals enables correct insulin doses for best glucose control. Hydration should be maintained by drinking water and other non-sweetened drinks at regular intervals during non-fasting hours. Minimize intake of caffeinated beverages (tea, coffee, soda) because they act as diuretics, which can lead to dehydration. The pre-dawn meal (Suhoor) should be as late as possible, especially if fasting for longer than 10 hours. The Suhoor meal should include a larger portion of protein and low-glycemic index carbs to help decrease hunger during the day. Begin Iftar with plenty of water to rehydrate after fasting and have 1-3 small dried or fresh dates to help raise blood glucose levels. 2 Better Choices: Fruits & Vegetables Commonly Food Serving Size Carbohydrate** Eaten Foods Dried Figs 2 figs (28 g) 16 g 1 date (19 g) 6g Fresh dates During Ramadan 3 dates (57g) 18g 1 date (6 g) 5 g Dried deglet date 3 dates (18 g) 15 g Dried Medjool date 1 date, pitted (24g) 18 g 1 half (6 g) 2 g Dried apricot 8 halves (48 g) 18 g Sultanas Snack pack (40 g) or ¼ cup 30 g Dried barberries ¼ cup (37 g) 20 g Poor Choices: Cakes, Pastries & Sweets* Food Serving Size Carbohydrate** Chocolate-Arabian Delights 1 piece (11 g) 7 g (chocolate coated dates with nut inside) Mouhalabieh (Milk flans) 1 cup (200 g) 30 g Galactobureko (filo custard pastry, syrup soaked) 1 piece (2 in x 2 in) 28 g Baklava 1 piece (50 g) 26 g Turkish Delight 1 piece (18 g) 15 g Kanafeh 1 square, 6 tablespoons (120 g) 40 g Halva (nut butter-based e.g. tahini) 2 tablespoons (50 g) 22 g Ghraybeh (butter cookies) 1 cookie (15 g) 7 g Ma’mool / maamoul / ma’moul 1 cookie (35 g) 23 g (cookies stuffed with walnuts/dates) Basbousa (sweet semolina cake soaked in syrup) 1 slice (30g, 3 cm x 3 cm) 14 g Sekerpare (butter cookie soaked in syrup) 1 piece (18 g) 16 g Tulumba (fried dough soaked in syrup) 1 piece (35 g) 37 g Lokma (sweet fried dough) 1 ball (13 g, 2 cm) 10 g * May have more saturated fats. **Carbohydrate amounts are best estimates and may vary by brand or method of food preparation. Using a food scale to measure the weight of the food in grams can help with accurate carb counting. 3 Example Plate https://www.idf.org/our-activities/education/diabetes-and-ramadan/healthcare-professionals.html Carb Needs for Ramadan Based on Calorie Needs Calories per day 1500-1600 1800 2000 Carbs per day 170-190g 200-225g 225-250g Suhoor Carbs 50-80g 60-90g 70-100g Iftar Snack Carbs 20-40g 20-45g 20-50g Iftar Meal Carbs 70-100g 80-115g 90-125g 2nd Snack Carbs 20-40g 20-45g 20-50g Males ages (years) 9-10 11-12 13+ Females ages (years) 9-13 14-18 18+ https://www.idf.org/our-activities/education/diabetes-and-ramadan/healthcare-professionals.html 4 1500-1600 1800 calories/day calories/day https://www.idf.org/our-activities/education/diabetes-and-ramadan/healthcare-professionals.html 5.