1. Fasting and Diabetes Dr Shahkur Shabir GP ST2 Half Day Release November 2011

2. What is fasting? Fasting is an important spiritual aspect of many religions, such as Islam, Hinduism and Judaism. It is the abstinence from food (and sometimes drink),

3. Who fasts Depending on the religion, fasting will last for different lengths of time. In Hinduism and Judaism there tend to be individual days of fasting. However, the Islamic month of Ramadan is one of the longest periods of fasting, when it is compulsory for all healthy Muslims to fast between the hours of sunrise and sunset.

4. However, people with diabetes do not have to fast during Ramadan. Many people still wish to fast. So its our duty to advise them best we can.

5. Type 1 diabetes Type 1 diabetes: danger of high blood glucose levels (known as hyperglycaemia) and result in a build up of 'ketones'. This could potentially result in a serious condition known as ketoacidosis. The symptoms of high blood glucose levels might include feeling very thirsty, passing a lot of urine and/or extreme tiredness.

6. Advice for people with diabetes who choose to fast The type of insulin may also need changing from your usual type. Check your blood glucose levels more often. Continue a varied and balanced diet. Try not to have too many sugary and fatty foods.

7. Include more slowly absorbed foods that have a lower glycaemic index. – Examples: rice, pasta, wheat When you break the fast, ensure you drink plenty of sugar-free and decaffeinated drinks to avoid dehydration. Speak to your healthcare team if you are planning to fast.

8. IMPORTANT TO EDUCATE RISKS OF DIABETES Hypoglycaemia- can lead to collapse and fitting. A responsible person in the family should be supplied with Glucose gel (hypostop) and Glucagon injection. Give oral sugar as soon as patient is conscious.

9. OTHER COMPLICATIONS Diabetics are 2-5 times more likely to have MI and 3 times Strokes. Badly controlled Diabetes can lead to Kidney failure and patient may end on dialysis. 1 in 3 patients have eye problems on the time of diagnosis. Diabetes increases the risk of cataract, Glaucoma and retinopathy-(can lead to blindness).

10. Autonomic Neuropathy Postural Hypotension Erectile Dysfunction Urinary retention Diabetic diarrhoea

11. Diabetes predisposes patients to Depression PERIPHERAL NEUROPATHY- Reduced foot sensation which can lead to ulcers. AMYOTROPHY Painful wasting of quadriceps muscle

12. It is important to respect all religions and patients beliefs. It is our duty to best advise the patient of possible risks so they can make an informed decision.

13. THANK YOU