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Don Mills Diabetes Education Program

Don Mills Diabetes Education Program . Indubala Shekhawat RD CDE. Fasting for Ramadan and Considerations for Diabetes Management. Agenda. Meals changes -3 v/s 2 (day v/s night) Healthy option & portion size Safety tips – Hypo . Muslims in Canada.

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Don Mills Diabetes Education Program

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  1. Don Mills Diabetes Education Program Indubala Shekhawat RD CDE Fasting for Ramadan and Considerations for Diabetes Management

  2. Agenda • Meals changes -3 v/s 2 (day v/s night) • Healthy option & portion size • Safety tips –Hypo

  3. Muslims in Canada • 600,000 Muslims in Canada (Muslim–Canada.org, 2001) • Represent different ethnic background, nationalities, languages and cultures- so does food • Immigrated to Canada from: Arab (Lebanon, Egypt, Palestine, Syria, Morocco), Asia • Africa, Europe, South and Central America.

  4. Psycho-social Impact • Fasting is a special act of worship between human and God • The purpose of fasting is piety • Peace and tranquility • Self regulation, and self training • Showing compassion • Avoiding immoral behavior & anger • Extra prayer at night • A time to strengthen family and community ties.

  5. Who are exempted from fasting? • Young children (pre-puberty) • Seriously ill persons • Pregnant and nursing mothers • Menstruating women • Long distance travelers (50miles) • Any one can break fast in an emergency • Fast as soon as you are well • Make up missed non fasting days by fasting as soon as possible • Charity (Zakat): provide food to needy people for missed days

  6. Following people are at high risk of complications and should avoid fasting: • Patient with type 1 diabetes • Patient with poorly controlled diabetes • Pregnant women with diabetes • Breast feeding mother on insulin • Very elderly person on insulin or living alone • Acutely ill or frail old individuals • If you had low blood sugar (hypoglycemia) recently • If you have other diseases such as kidney or heart diseases.

  7. Meals during Ramadan Sahri or Suhur: Light meal eaten prior to daylight Iftari: Breaking the fast with dates, juices or sugary beverages, figs, olives, honey, breads • Special (traditional) foods are prepared for this occasion high in calorie and sugar content • 3 day celebration of Eidul-Fitr marks the end

  8. Diet modification for type 2 Iftarmeal: Break 1 big meal after sunset into 2 meals. Eat light meal to break the fast Limit foods/beverages with high sugar content After 2 hours of Iftar: Eat healthy balanced diet Choose from all 4 food groups Limit/avoid deep fried food, rich traditional dishes. Do light exercise

  9. Suhurmeal Eat as late as possible (just 5 minutes before dawn) Eat low GI food: beans, lentils, whole grain breads, vegetables and fruits Hydrate well with liquids between meals Do not skip meals during non fasting hours Avoid caffeinated beverages (diuretic)

  10. Three “D”s for safer fasting • Drugs: You should not stop taking medication and insulin but you may need some adjustment in your medicine, speak with your physician and diabetes team • Diet: Have your Suhur meal just before sunrise, include slow digesting carbohydrate such as porridge and some protein, drink plenty of fluids • At Iftarmeal follow plate method and include lots of vegetables, choose real fruit instead of juices or sugary drinks. Include , lentils, yogurt and fruit. • Limit high fat food during non fasting hours. • Drink lot of sugar free fluids during non fasting hours. • Daily activity: do not over-exert yourself. You can continue regular physical activity such as walk after Iftar meal.

  11. Listen to your body cues • If you feel low blood sugar symptoms such as weakness, shaking, sweating blurred vision, tiredness. You MUST break your fast right away otherwise it could be dangerous ( you could end up in coma) • Treat low blood sugar (less than 4.0mmol/L immediately: • Drink ¾ cup or juice or regular soda or 1 table spoon of honey or 3 teaspoons of sugar dissolved in water or 3 glucose tablets.

  12. Thank you!

  13. References Al-Arouj et al, “Recommendations for management of diabetes during Ramadan,” Diabetes Care. 2005;28:9: 2305-2311 Al-Rubeaan, K, A. Dietary changes among diabetes patients during Ramadan in Saudi Arabia. Practical Diabetes International Supplement. 1998;15(1):s6-7 B.Benaji et al, “Diabetes and Ramadan: Review of the literature,” Diabetes Research and Clinical Practice 73(2006), 117-125 Duska, F, Andel, M, Kubena, A, et al. Effects of acute starvation on insulin resistance in obese patients with and without type 2 diabetes mellitus.ClinNutr. 2005; 24: 1056–1064 El-Ghomari, H (1998).Consensus on Diabetes treatment during Ramadan. Practical Diabetes International Supplement 15(1):s8-10 Gaman, A., M., Car, N., & Muacevic-Katanec, D . Fastign of persons with diabetes mellitus during Ramadan. DiabetologiaCroatica. 2002; 31(2), 2002

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