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Ramadan Fasting with Diabetes: A Comprehensive Nutrition Plan to Make It Possible


Fasting is a common religious practice that involves abstaining from food and drink for a certain period. For Muslims, the month of Ramadan is a significant religious observance as fasting is mandatory. However, for diabetic patients, fasting can be challenging and potentially harmful if not managed properly.


Hence, the Ramadan Nutrition Plan (RNP) was introduced in 2021 by the Faculty of Medicine and Health Sciences, University Putra Malaysia to help diabetic patients fast safely while maintaining their blood sugar level and help to achieve a healthy weight that further improves the diabetic condition.


The RNP is based on ten principles as follows:

1. Get a doctor's or a dietitian's advice before deciding to fast

Besides helping the patients determine whether it is safe to fast, the doctor may adjust the medication or insulin dosage to help manage the blood sugar levels during Ramadan. It is crucial for a diabetic patient to not self-adjust or stop medications on their own.


2. Eat adequate amounts of calories and carbohydrates

To maintain reasonable blood sugar control, a diabetic patient must distribute the carbohydrates uniformly during the pre-dawn (sahur), break fast (iftar), and snack meals.


3. Ensure the macronutrient proportions are balanced

A diabetic patient can achieve a balanced diet by ensuring the total calorie intake comprises 45 - 50% carbohydrate, 20 - 30% protein, and not more than 35% fat. A dietitian's role is essential for more guidance on fulfilling a diabetic patient's macronutrient needs according to their food preference.


4. Use the 'Ramadan Plate' as a guide to ensure a balanced meal for sahur and iftar meals.


When using the 'Ramadan Plate' as a guide, it is highly recommended to consume vegetables first because fiber intake can help a diabetic patient feel full quicker and tends to choose lower GI foods afterward. In addition, this eating habit helps reduce post-meal glucose levels and lowers HbA1c levels. Besides contributing to healthy blood sugar management, a high fiber intake successfully help in body weight control.

5. Choose carbohydrates that are low in GI and high in fiber

The glycaemic index (GI) is a rating system for carbohydrates in food. It shows how quickly each food affects the blood sugar level when eaten independently. In general, low-GI food can be a helpful tool to help in managing diabetes. At the same time, high-fiber food is essential for blood sugar and body weight management. Whole-grain products such as brown rice, whole-grain bread, and oat are among the examples of carbohydrate foods that are low in GI and high in fiber.


6. Delay sahur mealtime

Sahur is essential for diabetic patients to provide long-lasting energy throughout the day and prevent low blood sugar levels (hypoglycemia) for diabetic patients. In addition, eating sahur as late as possible is beneficial to reduce the length of fasting.


7. Break the fast with a small snack followed by prayer. Then, eat a balanced breaking fast meal.

A small snack such as a glass of water and 1 - 3 fresh dates will help to raise blood sugar levels slowly before preparing our body for a heavier and more balanced meal afterward.


8. Drink adequate water

Drinking adequate water during the non-fasting hours is vital to maintain hydration. It is encouraged to drink eight glasses of water and non-sweetened beverages. Try to limit or avoid the intake of sugary drinks, such as canned juices or fresh juices with added sugar. Other than that, reducing the intake of caffeinated beverages such as tea, coffee, and cola drinks and eating high-salt food such as salted fish and food that is cooked using a lot of condiments is also advised because they can lead to dehydration.

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9. Diabetes-specific formula (DSF) intake

DSF is a formula containing specific nutrients that helps achieve body weight and optimum blood sugar control. It can be taken as a part of a sahur meal or snack as a part of healthy Ramadan eating habits while managing diabetes.


10. Include healthy snacks if needed

Diabetic patients can eat 1 - 2 healthy snacks during the non-fasting period, such as one piece of fruit, a handful of nuts, or boiled chickpeas. The recommended time is one snack during iftar and another for supper.


A study shows that following a structured nutrition plan such as RNP, which includes diabetes-specific formula, compared to the standard care during Ramadan fasting for type 2 diabetic patients achieves a lower fasting plasma level, triglycerides, and reduction of HbA1c levels. This shows that RNP is something that a diabetic patient can consider to manage their blood sugar levels and reduce the risk of diabetes-related outcomes.


Besides practicing a healthy and balanced diet according to the RNP during Ramadan, self-monitoring of blood glucose (SMBG) is essential for diabetic patients. Generally, it is recommended to perform SMBG during these times: sahur, midday, pre-iftar, and any time when a patient experiences symptoms of hypoglycemia. If the blood sugar level is below 3.9 mmol/L or above 16.7 mmol/L, they should break the fast to avoid harmful health effects.


Conclusion

Ramadan is a holy month for Muslims worldwide where they will fast to fulfill one of the five basic tenets of the religion. However, this act can be challenging for people with chronic medical conditions such as diabetes; hence a structured nutrition plan such as RNP can be considered to fast safely. It is also worth reminding that prioritizing health by breaking the fast is essential to avoid any detrimental side effects, and it is permissible according to the ruling of Islam.


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