1. Diabetes in the Holy Month of Ramadan Dr. M.K. Abedi

2. Why are we here today? Islam is the second largest religion in the London Borough of Enfield. Diabetes is most common amongst Asian patients. This year Ramadan is expected to begin on 28 th June 2014 at the sighting of the new moon Ramadan will end on 28 th July 2014

3. Diabetes and Ramadan Diabetes is a condition in which the amount of glucose (sugar) in the blood is too high because the body cannot use what we eat properly. During the Holy Month of Ramadan people change their eating habits. This may affect blood glucose levels in a way that can make some people feel very unwell. We are here to give you information on how to stay well.

4. Fasting in 2014 This year you will be fasting for up to 19 hours July may also be very hot Peak temperature in London is 30 0 C ( 90 0 F) Average temperature in London is 22 0 C (70 0 F)

5. If you have diabetes You need to make an appointment to see your General Practitioner or Practice Nurse What needs to be considered:  What treatment are you on?  Has your health been generally good in the last year?  Are your blood glucose levels generally well controlled?  Do you have diabetes complications?  How have you managed during Ramadan before and how have you felt?

6. If you have diabetes who should not fast? If you have recently been diagnosed If you have Type 1 or Type 2 diabetes that is not well controlled If you have hypo unawareness If you are elderly or frail If you have a history of diabetic ketoacidosis If you have been having recurrent infections If you have kidney problems If you have had problems fasting before If you have unstable epilepsy

7. What are the risks of fasting for Ramadan if you have diabetes? Hypoglycaemia  Low blood glucose levels Hyperglycaemia  High blood glucose levels Dehydration  Lack of fluid in the body

8. Symptoms of Hypoglycaemia or Low blood sugar These vary from person to person Confusion Dizziness Drowsiness Headache Hunger Fast heart rate Sweating Weakness Feeling jittery Irritability

9. Causes of hypoglycaemia If you take insulin, you may have taken too much Lumpy injection sites You may have reduced the amount of carbohydrate in your diet You may have delayed or missed a meal Increased stress levels Increased your physical activity Hot weather can affect some people Some drugs can cause hypoglycaemia

10. Treatment for hypoglycaemia Check blood glucose level if possible Eat or drink something sweet  Lucozade 50 – 100 mls  Or Coke 50 – 100 mls (NOT DIET COKE)  Or 3 – 6 glucose tablets  Repeat if symptoms are not resolved after 5 – 10 minutes When feeling less unwell, eat your next meal or have a snack like a sandwich or a banana If you are getting episodes of hypoglycaemia you will need to visit your GP

11. Symptoms of hyperglycaemia or high blood sugar Weight loss Increased thirst and dry mouth Tiredness Blurred vision Headache Loss of concentration Frequent urination

12. Causes of hyperglycaemia You have stopped your medication You are taking the wrong dosage of your medication You have reduced the amount of activity that you do You have changed your diet

13. Treatment for hyperglycaemia Take correct dosage of medication at the correct time Take regular physical exercise Avoid changes to healthy eating plan See your GP if symptoms persist

14. General precautions for Ramadan Plan your meals carefully Do not skip meals Avoid over eating at Iftar or Sehri Continue to take your medicines as prescribed by your doctor If Type 1 diabetes check for ketones if blood glucose level is high (>14 mmols) Drink plenty of sugar free drinks Know who to contact if in an emergency

15. Your Diet If breaking fast with dates and milk, if diabetes is present dates should be limited to a maximum of 3 Limit or avoid sweets and fried foods at the start and break of your fast Try to fit in 5 portions of fruit and vegetables a day Fill up on starchy foods like rice, chappati, couscous, wholegrain bread Eat foods higher in fibre as these are more filling and can prevent constipation Drink lots of fluids before fasting commences

17. Medication There are leaflets available today that will give you further guidance about your medications for diabetes and how fasting may affect how they work If you are concerned about your tablets, contact your GP or Practice Nurse.

18. Other possible health problems during Ramadan Headache:  Try to eat foods that have a slower absorption rate e.g. grains and pulses. Constipation:  Drink plenty of fluids and eat foods that are high in fiber. Indigestion:  Reduce fried foods and eat smaller portions at a time.

19. We wish you all a healthy Ramadan