Diabetes and Fasting

 

1.  Is it Ok for me to fast during the Holy Month of Ramadan, if I am living with diabetes?

 

During fasting, about eight hours after the last meal our bodies start to make use of energy stores to keep blood glucose (sugar) levels normal. For most people, this is not harmful.

However, a problem can occur if you are living with diabetes, such as the risk of high glucose levels following the larger meals that we eat before and after fasting at Suhoor and Iftar.

A lot depends on how well your diabetes is controlled, especially if you’re prone to either frequent high blood sugar levels (Hyperglycaemia), or low blood sugar levels (Hypoglycaemia).

Of course, this year the fasting period is long (approximately 15 hours in the UAE) meaning that the risk of Hyperglycaemia (high blood sugar levels) and dehydration (lack of water) is high.

It is very important that anyone living with Type 1 diabetes understands that they are at a higher risk compared to those with Type 2 diabetes when fasting during the Holy Month of Ramadan.

In general, people living with Type 1 diabe­tes are strongly advised to not fast during Ramadan.

If you are a Type 1 diabetes patient and intend to fast, it is very important that you are closely supervised by your doctor and ensure that your blood sugar is regularly monitored to mitigate health risks.

If you are living with Type 2 diabetes, generally it is safe to fast during Ramadan, but this may not be so for everyone living with Type 2, so it is important that you speak with your doctor about your plans. This way you can be sure to include your doctor’s advice to ensure your good health while fasting.

Be mindful that your ability to fast safely often depends on your prescribed medication, and therefore it is important for you and your doctor to assess your medication programme before the start of Ramadan and/or your fast. Your doctor will guide you to create a fasting plan which works for you.

For example, if you are taking certain tablets and/or insulin, fasting carries the risk of both low and high blood glucose levels. In extreme cases both can lead to Diabetic Ketoacidosis (DKA), a serious condition often requiring swift hospital treatment.

2. What happens to my body during fasting?

During fasting, at about eight hours after the last meal, our bodies start to use energy stores to keep our blood glucose (sugar) levels normal. For most people, this is not harmful.

However for someone living with diabetes, especially if you take certain tablets or insulin, you are at risk of Hypoglycaemia (low blood glucose levels), Hyperglycaemia, (high glucose levels) and dehydration (lack of water).

3. If I am living with Type 1 diabetes, is fasting risky?

In general, people living with Type 1 diabe­tes can be at high risk of develop­ing severe complications, and are strongly advised to not fast during Ramadan.

If you are living with Type 1 diabetes and really do want to fast, you must consult with your doctor before embarking on the daily fast, and work closely together throughout the fasting period.

4. What are the risks if I fast and I am living with Type 2 diabetes?

If you are living with Type 2 diabetes and have successfully embraced a healthy lifestyle by maintaining a normal body weight through a practice of a balanced diet and regular physical activity, the risks associated with fasting are reduced. Do discuss this with you doctor.

However, following a period of fasting if a very large, excessive meal is consumed there is a potential risk of post-meal Hyperglycaemia (high blood sugar) after the pre-dawn and sunset meals.

One simple solution is to distribute energy intake over two to three smaller meals during the non-fasting interval. This may help you avoid post-meal Hy­perglycaemia.

As with diet, your daily exercise should be less intense to avoid episodes of Hypoglycaemia (low blood sugar).

If you are taking prescribed oral medications and insulin, consult your doctor to discuss the risks, which vary from person to person.

5. If I am living with diabetes, do I need to go on a special diet during Ramadan?

The good news is if you are already following a balanced diet, as is recommended for everyone, living with Type 2 diabetes or not, then there is a big chance that you do not have to change the ingredients of your diet.

In fact, you should eat as you normally do, with the only difference being the time you eat your meals, rather than quantity or type of food consumed.

The Ramadan diet should be kept simple and contain foods from all the food groups including:

• Bread, cereals or rice
• Meat, chicken, fish or beans
• Milk, laban or yogurt
• Fruits and vegetables

Iftar is the meal that breaks the fast, just after sunset, after the long hours of fasting. It is important however that it remains a meal and does not become a feast!

One other thing to be particularly aware of is the risk of increasing blood sugar levels after Iftar, especially if you eat sweet food.

Also, you must take special care to drink plenty of water during the non-fasting hours, so that you remain comfortably hydrated during fasting hours.

At Suhoor, just before dawn, you should eat starchy carbohydrates which release energy slowly, such as multigrain bread, oat-based cereals and basmati rice, together with beans, lentils, fruit and vegetables.

Other foods which will keep your blood glucose levels more stable throughout the fast include Arabic bread, chapattis and semolina.

As with all meals, eat sensibly, do not over eat and remember to drink plenty of water.

6. What are the risks of fasting while living with diabetes during pregnancy?

Pregnant women are advised not to fast, on medical grounds.

However, some still like to fast and if diabetes (including gestational diabetes) is also present, this is considered a high-risk scenario that requires special care during the fasting period.

For example, pregnancy involves a state of increased insensitivity to insulin and insulin secretion. During fasting, blood glucose levels are generally lower but after a meal, glucose and insulin levels remain substantially higher in healthy pregnant women than in women who are not pregnant.

Also, elevated blood glucose levels during pregnancy may be associated with increased risk for major congenital abnormalities.

It should also be remembered that the issues concerning the management of Type 1 diabetes and Type 2 diabetes also apply to pregnant women, along with more frequent monitoring and insulin dose adjustment, under the guidance of a doctor.

7. Is it Ok for children to fast, and what are the guidelines?

Most children do not fast until they reach the age of puberty. However, in many families, younger children enjoy participating during Ramadan.

Under the watchful eye of the child’s doctor, it is important to make children aware of what fasting involves and to then to practice fasting for only a few hours at a time, although fasting for children under the age of eight isn't advisable.

Children living with diabetes who choose to fast during Ramadan require special attention by paediatricians as the majority of guidelines and data on safety and metabolic impact of fasting are based on practice and studies on the adult population.

8. Is there an increased risk of dehydration in hot countries, like the UAE?

Dehydration due to reduced intake of fluids may become severe in hot and humid climates like the UAE, especially among those who perform physical labour.

On top of this, Hyperglycaemia (high blood sugar) can result in the loss of body fluid through excessive urination, and contribute to depletion of electrolytes in the body.

Also, people with pre-existing nerve damage may develop symptoms of low blood pressure like dizziness or light-headedness. This can lead to loss of consciousness and falls sometimes leading to injuries, such as bone fractures.

It is very important that fluid intake during non-fasting hours from Iftar through to Suhoor is maintained at a regular pace.

9. In the UAE it is very hot during Ramadan. What can people do if they wish to exercise during the Holy Month?

It is good to take some moderate exercise just before you break your fast at Iftar, and again just before going to bed, as well as right before Suhoor.

It will be quite warm during Ramadan this year and outdoor exercise might not always be the best option, so try including indoor activities like climbing the stairs. Start slowly and gradually with two flights at a time and refrain from pushing yourself too hard during the first few days.

Of course, after the sun sets and just before dawn breaks a short but brisk walk for at least 10 minutes is a good practise to adopt during Ramadan.

If you decide to pop out to a mall in the evening, park farther away from the entrance, walk the extra distance, and also enjoy a brisk walk around the mall walkways before your embark on your seasonal shopping!

10. Do I need to wake up for Suhoor?

Long hours without eating increases the risk of Hypoglycaemia, or low blood sugar.

You must try to eat a meal at Suhoor just before sunrise, and not only before going to bed. This will help to keep your glucose levels more balanced throughout the fast.

11. Should I stop taking insulin?

You should continue taking your insulin however it is important to speak to your doctor before you start fasting because you may need to change the dose and times of your insulin injections.

12. If I smoke, is Ramadan a good opportunity to give up?

For everybody, and especially if you have diabetes, smoking increases your risk of heart disease. Since you are not allowed to smoke during fasting hours, there is a great opportunity to stop smoking altogether. Speak with your doctor to learn about the many ways to help you quit smoking.

Ramadan Fasting Tips From ICLDC

13. Here are some guidelines to help you enjoy fasting during the Holy Month of   Ramadan, and at other times that you choose to fast.

Talk To Your Physician

It is possible to manage diabetes and fast, but make sure you meet with your doctor for a thorough assessment before you start your fast, especially if you are taking prescribed medication.

Your doctor will guide you how to adjust your doses and help create a plan that works for you in complement to Ramadan fasting hours.

Space Out Your Meals

It is a good idea to pace your meals, just as you do normally.
During Ramadan, avoid eating continuously from Iftar to just before Fajr, rather pace your meals by enjoying small portions at regular intervals.
At Iftar, try breaking your fast with a light snack such as dates and soup. Then, have a full meal about an hour later. Do make sure you take Suhoor, the meal  just before Fajr.

Re-Hydrate Well

It is important that you do not get dehydrated.    
Drink plenty of water and avoid sugary drinks.
A sudden surge of sugary drinks in your system can result in a state of high blood glucose levels that must be avoided.

Don’t Skip Meals - Have Iftar and Suhoor

Remember to eat a balanced meal after Iftar, and just before Fajr. If you are on medication, this will help will reduce blood glucose levels.

Consume Good Carbohydrates; Consider Your Options

Slow release carbohydrates, known as low-glycaemic, are an excellent option. These include wholegrain bread and basmati rice.
Fast release carbs, sugary food, and food otherwise known as high-glycaemic, are best avoided. High glycaemic starchy foods include potatoes and white bread.

Moderate Activity Is Good

Moderate physical activity every day is a healthy option.
Walking is one of the best recommended activities for moderate exercise.
However excessive exercise is best avoided for people who are fasting.

Insights On Fasting

14. Do people tend to lose weight during Ramadan?

Ramadan isn’t always thought of as being an opportunity to lose weight because the spiritual aspect is emphasised more generally than the health side. But fasting during the Holy Month can lead to moderate weight loss, if it is practised correctly.

When the body receives less food, it starts to burn fat so that it can make energy. This can lead to weight loss.

However, if you fast for too long your body will eventually start breaking down muscle protein for energy, which is unhealthy. This is unlikely to happen during Ramadan as you will break your fast daily and the body's energy can be replaced during the pre-dawn and dusk meals.

This provides a gentle transition from using glucose as the main source of energy, to using fat, and prevents the breakdown of muscle for protein.

The use of fat for energy helps with weight loss. It preserves the muscles and eventually reduces your cholesterol level. In addition, weight loss can result in better control of diabetes, and reduce blood pressure.

However, if one does eat more than normal during Ramadan, this can and does have adverse effects, including weight gain.

15.   How can people avoid putting weight on during and/or after Ramadan fasting?

If you are not careful, food eaten during the pre-dawn and dusk meals can cause some weight gain if you are eating in excess. As you approach the fast with discipline, the same approach should be used during non-fasting hours.

Food intake (during Iftar and Suhoor) should be simple and not differ very much from your normal diet. It should contain foods from all the major food groups:

•     Fruit and vegetables
•     Bread, cereals and potatoes
•     Meat, fish, or alternatives
•     Milk and dairy foods

Foods to avoid are the heavily processed, fast-burning foods that contain refined carbohydrates, such as sugar and white flour, as well as fatty food, for example cakes, biscuits, chocolates and sweets.

It's also helpful to avoid caffeine-based drinks, especially sodas and cola. Caffeine is a diuretic and can stimulate faster water loss through increased urination.

Foods To Avoid

•     Deep-fried foods, for example pakoras, samosas and fried dumplings
•     High-sugar and high-fat foods, including sweets such as gulab jamun, rasgulla and balushahi
•     High-fat cooked foods, for example, parathas, oily curries and greasy pastries

Healthy Alternatives

•     Baked samosas and boiled dumplings
•     Chapattis made without oil
•     Baked or grilled meat and chicken
•     Homemade pastry
•     Milk-based sweets and puddings, such as rasmalai and barfee

Cooking Methods To Avoid

•     Deep frying
•     Excessive use of oil

Healthy Cooking Methods

•     Shallow frying
•     Grilling or baking is healthier and helps retain the taste and original flavour of the food, especially with chicken and fish

16.   How can indigestion be best avoided after a day of fasting?

Indigestion is common in those fasting, and can often occur when you break your fast with the Iftar meal. The problems are varied, including abdominal distension, constipation and vomiting.

Put simply, the body has trouble coping with the sudden, high intake of food, leading to indigestion and heartburn.

Another problem is that many tend not to exercise during Ramadan, preventing food from being properly digested. Exercise is very beneficial for healthy digestion, because movement helps stimulate the natural contraction of intestinal muscles, encouraging the food to move through your intestines more rhythmically.

Generally, problems occur when people try to eat too much too soon. It’s important not to try to consume the amount of food normally taken over an entire day in just six-eight hours.

Instead, at Iftar take it slow and eat gradually, beginning with fluids and non-fatty, low calorie food.

If you’re a smoker and break the fast with a cigarette, this can also leads to heartburn and indigestion.

17.   What are the best drinks to take during Ramadan to both quench thirst and offer nutrition?

Water is the most important fluid to replenish your thirst during Ramadan. Unfortunately though, some people do not drink enough and have only small amounts at Iftar and then forget to drink water until the next day!

Water plays a significant role in weight loss and maintenance, because it helps to get rid of toxins and reduce the feeling of hunger.

Try not to drink large quantities of water all at once or a lot during a meal. Instead drink water between your meals and drink small quantities of water throughout the night.

In addition to water, drink fresh fruit or vegetable juices rather than sweetened ones, and avoid sugary sodas.

18. What are the health guidelines on smoking shisha and/or cigarettes during Ramadan?

Smoking is not conducive to a healthy lifestyle and is not recommended at any time. Unfortunately for some, the tendency can be to chain smoke after breaking the fast, a  habit considered by some to be even more challenging to health than normal smoking  because you are inhaling more smoke over a shorter period.

Indeed, most experts see Ramadan as an ideal chance to give up smoking or shisha. While it can be challenging when the hours of fasting are long, during this time the nicotine level in the blood reduces and can even help smokers stop completely.

Diabetes Facts and Figures

19. How many people have diabetes, worldwide, and where does the UAE rank?

The latest figures from the International Diabetes Federation (IDF) suggest that 387 million people are living with diabetes, worldwide.

In the UAE, diabetes currently affects 19.02 per cent of the population, placing the nation 16th worldwide for countries with the highest diabetes prevalence per capita.

It is also important to note that diabetes is a regional challenge. Saudi Arabia, Bahrain, Kuwait and Qatar all feature in the top fifteen countries, worldwide.

These statistics indicate that the region has high risk factors for diabetes, mostly related to rising obesity rates and physical inactivity.

Indeed, rapid economic growth, sedentary lifestyle and unhealthy diets have all contributed to increased obesity and have fuelled diabetes prevalence in the region.

It is important that we stay focused on educating region-wide populations on the management and prevention of diabetes.

20. What causes diabetes?

Diabetes is a condition that is characterised by an above normal level of glucose (sugar) in the blood. It is also characterised by either a relative or absolute deficiency of insulin. This is because the pancreas does not make enough insulin or insulin becomes ineffective.

Insulin, a hormone generated in the pancreas, normally controls blood sugar levels and allows the glucose to enter the cells in the body to provide energy.

In Type 2 diabetes resistance to insulin is aggravated by obesity. In people with diabetes, high levels of glucose remain in the bloodstream causing Hyperglycaemia (high blood sugar).

Those at increased risk include individuals who have a history of diabetes in their family, people over 40, those who are overweight or obese and inactive individuals. Many people with Type 2 diabetes are overweight and obese and this is an important factor in causing diabetes.

Type 1 diabetes is an auto-immune condition where the pancreas is attacked by auto-antibodies causing it to fail. It mostly develops before adulthood in younger people and remains with them throughout their life.

Type 2 diabetes on the other hand is mainly brought on by an unhealthy, inactive lifestyle, weight gain and genetics. Obesity is known to increase the risk of developing Type 2 diabetes in adulthood.

21. What are some of the symptoms that could indicate diabetes?

Usual symptoms include thirst, passing urine frequently and tiredness. However, these symptoms often go unnoticed. Many people have diabetes without having any symptoms and without knowing they have it. This is why it is so important for people to have screening tests, especially if they are at risk.

22.  What is the age range of people affected?

People of all ages can be affected by diabetes, with most people living with diabetes being between 40 to 59 years of age, however recent research is showing a rise among younger age groups.

As for gender distribution, the International Diabetes Federation suggests a female predominance in the number of persons living with diabetes, with some figures suggesting that female numbers are about 10 per cent higher than for males, rising to 20 per cent in pre-diabetes.

Obesity is widely regarded as the number one risk factor for Type 2 diabetes. Extra body weight means a higher risk of insulin resistance because fat interferes with the body's ability to use insulin.

Weight gain can often result in an increase in fat inside the abdomen – the so-called ‘visceral fat’ that cannot be seen or felt. The presence of this fat changes the metabolism of the body to predispose it to the metabolic syndrome, which includes possibilities of diabetes, high cholesterol, and high blood pressure.

Recent statistics show a rise in childhood obesity in recent years, suggesting that 10 per cent of children and adolescents – especially between 16 and 17 years old, suffer from obesity, worldwide.

Indeed, there has been an increase of Type 2 diabetes in younger people due to obesity linked to physical inactivity and unhealthy diets.

23. We are seeing more children with Type 2, even though it normally only appears in adults over the age of 40. Why is that? And what should parents do?

The International Diabetes Federation and other leading research sources suggest that Type 2 diabetes is mainly brought on by an unhealthy, inactive lifestyle and weight gain. In recent years, we have seen a spread over all age groups – and this also includes children.

Indeed, among children Type 2 diabetes is quickly becoming recognised as a global public health issue with potentially serious health outcomes.

As there is an increased risk of developing diabetes with obesity, the most important thing parents can do is to encourage their children to lead a very active lifestyle with regular exercise. This can be anything from playing a sport regularly to a simple daily 30-minute brisk walk together, or even doing a household chore.

Parents must ensure that their children also have a healthy diet which includes low fat and nutrient-rich foods like fruits and vegetables. At the same time parents should limit sugary foods and drinks like sweets, chocolate and fizzy sodas.

If you’re worried that your child may be overweight and at risk of developing Type 2 diabetes you should see your doctor or dietician and they will be able to advise you how to best to manage your child’s weight and general health.

In the UAE, we are hopeful that through Imperial College London Diabetes Centre’s public health awareness campaign, Diabetes.Knowledge.Action, we are able to support children and adults alike living with, or at the risk of developing, diabetes.

Through ongoing research, we also hope to determine why diabetes occurs at such high levels in the country and instigate further preventative measures.

24. What are the main causes of diabetes in the UAE - the triggers and factors contributing to diabetes?

According to the International Diabetes Federation’s World Diabetes Atlas 2014, the UAE is ranked 16th worldwide, with 19.02 per cent of the UAE population living with diabetes.

Researchers believe there is a genetic predisposition to the disease among UAE nationals and statistics show that they have a higher prevalence than other nationalities within the UAE.

Diabetes is a condition that is characterised by an above normal level of glucose (sugar) in the blood, and by either a relative or absolute deficiency of insulin.

This is because the pancreas does not make enough insulin or insulin becomes ineffective.

Insulin, a hormone generated in the pancreas, normally controls blood sugar levels and allows the glucose to enter the cells in the body to provide energy.

Tendencies towards an inactive lifestyle, weight gain, an imbalanced diet and/or a lack of exercise seem to be major contributors.

Research is on-going with the overriding aim to help explain why diabetes occurs at such high levels in the country. This will also help instigate preventative measures.

In Type 2 diabetes, resistance to insulin is known to be aggravated by obesity.

In people living with diabetes, high levels of glucose remain in the bloodstream causing hyperglycaemia (high blood sugar).

Individuals who could be at increased risk of developing Type 2 diabetes include:

•     those who have a history of diabetes in their family
•     those who are overweight or obese
•     those with an inactive lifestyle
•     people over 40

Indeed, it does seem that many people with Type 2 diabetes are overweight and/or obese and this is an important factor in promoting the onset of diabetes.

25. How many people are believed to have diabetes but are undiagnosed?

According to the International Diabetes Federation’s Diabetes Atlas in 2014, around half of the estimated 387 million people with diabetes worldwide are unaware they have it.

This places around 190 million estimated to be undiagnosed, as the symptoms of diabetes can be hard to detect.

There is a similar trend in the UAE as the IDF estimates again that just under half of the people with diabetes are unaware that they are living with the condition.

26. What are some of the serious effects of diabetes you are seeing in the UAE?

Diabetes can bring about serious complications related to the heart, eyes, blood vessels, kidneys, feet and nerves, when not managed correctly, including:

Diabetic eye disease - diabetic retinopathy is a key cause of blindness, occurring as a result of long-term accumulated damage to the small blood vessels in the retina.

Diabetic neuropathy - this is damage to the nerves as a result of diabetes, and seems to affect up to 50 per cent of people living with diabetes. Although many different complications can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.

•     Diabetes is among the leading causes of kidney failure.
•     Diabetes increases the risk of heart disease and stroke.

27. Is the UAE population offered much awareness of diabetes and how to prevent it?

The UAE is taking great steps through a number of nutrition and physical activity programmes, in addition to driving public awareness campaigns.

Certainly, at Imperial College London Diabetes Centre we have contributed with a public health awareness campaign, Diabetes.Knowledge.Action.

Launched in 2007 under the patronage of Her Highness Sheikha Fatima bint Mubarak, Diabetes.Knowledge.Action is our multi-faceted public health awareness campaign.

Diabetes.Knowledge.Action is focused on disseminating knowledge surrounding diabetes prevention, symptoms and lifestyle support activities, and has reached out directly to more than 200,000 people in the UAE.

The campaign shares the smart simple steps to maintain a healthy life, the risks of an unhealthy life, the complications that diabetes brings with it, while making available the latest evidence-based treatments.

It aims to help prevent the number of diabetes patients through education and encourage testing for diabetes on a nationwide level so that people learn if they are affected or at risk.

The campaign’s main aim is to communicate how easy it is to maintain a healthy lifestyle by adopting a balanced diet and taking a 30-minute brisk walk each day.

The campaign presently has four pillars and a number of community events and initiatives throughout the year:

• Eat for Life invites children, parents and carers to consider what makes a balanced diet.
• Cook for Life looks to inspire families to cook healthy meals.
• Play for Life promotes regular exercise for healthy living to corporate teams.
• Walk for Life encourages the community to take at least a 30-minite brisk walk each day. Now in its ninth year, thousands are again expected to join in the nation’s leading annual Walk 2015 in November.
• The campaign rolled out a host of mini-walks across the UAE with millions of steps taken by schools and organisations in support of #StartWalking, a grassroots community initiative.

28. Here are some recent seasonal quotes from ICLDC’s specialists:

Chairman of ICLDC’s Medical Board, Professor Karim Meeran, also Professor of Endocrinology at Imperial College London:

• “Regular exercise is one simple solution to encouraging healthy economies and lowering obesity rates…”
• “As simple as it may seem, a regular exercise practice really does work in helping to lower obesity, preventing and managing diabetes.”
• “With increased global awareness and education on healthy living, we can work towards becoming healthier nations. ICLDC’s Diabetes.Knowledge.Action campaign, now in its ninth year, is a great example of an engaging campaign which educates the community on the simple steps that can be taken to have a healthier lifestyle.”
• “We all have the ability to protect ourselves and those we care for by striving to maintain a normal body weight by simply adopting a balanced diet and a regular exercise practice…”

ICLDC’s Medical Director, Consultant Physician & Endocrinologist, Dr Saf Naqvi:

• “It's important to make children aware of what fasting involves and to then  practice fasting for a few hours at a time, although fasting for children under the age of seven or eight isn't advisable.
• “It is good to take some moderate exercise just before you break your fast at Iftar, and again just before going to bed, as well as right before Suhoor…”
• “It will be quite warm during Ramadan this year and outdoor exercise might not always be the best option, so try to include indoor activities like climbing the stairs. Start slowly and gradually with two flights at a time and refrain from pushing yourself too hard during the first few days…”

ICLDC’s Internal Medicine Specialist, Dr Farhana Bin Lootah:

• “Exercise is an important contributor to achieving and maintaining a healthy lifestyle, and can help reduce the risk of developing diabetes …”
• “As simple as it may sound, a brisk walk for 30 minutes a day, five times a week greatly reduces the chance of developing diabetes…”
•  “Exercise is especially effective in minimising the risk of diabetes especially when part of a three-way combination of a regular exercise practise, a balanced diet and maintaining a normal body weight…”
• “It makes absolute sense to maintain an exercise practice throughout the Holy Month, just changing the times for exercise and food intake according to the Ramadan timings …”

ICLDC’s Registered Dietician and Educator, Fatima Sadek

• “The good news is if you are already following a balanced diet, as is recommended for everyone, living with Type 2 diabetes or not, then there is a big chance that you do not have to change the ingredients of your diet during Ramadan…”
• “During Ramadan, slow release carbohydrates, known as low-glycaemic, are an excellent option for fasting food. These include wholegrain bread and basmati rice. Fast release carbs, sugary food and food otherwise known as high-glycaemic index are best avoided, such as potatoes and white bread…”
• “Ramadan isn’t always thought of as being an opportunity to lose weight because the spiritual aspect is emphasised more generally than the health side. But fasting during the Holy Month can be good for your health and can lead to moderate weight loss, if it is practised correctly…”
• “Indigestion is common in those fasting, especially when people try to eat too much too soon. Instead you should start your Iftar slowly, first with fluids, and eat non-fatty, low calorie food gradually …”