Diabetics must see doc before fast

Namrata Devikar
Tuesday, 7 May 2019

According to consultant diabetologist and Wise Diabetes and Research Centre Director Dr C Rao, our body’s system goes through a lot during fasting, depending on the length of fasting.

PUNE: Festivities in India are celebrated throughout the year. Most often these festivities are accompanied either by extensive fasting or over-indulgent feasting, which tend to ruin a healthy dietary plan. Doctors said diabetics are more susceptible to the dangers of fasting or excessive feasting during the festive period.

According to consultant diabetologist and Wise Diabetes and Research Centre Director Dr C Rao, our body’s system goes through a lot during fasting, depending on the length of fasting.

“With diabetic patients deciding to fast, it is important to manage the practice with proper precautions and care. The potential health hazards include hypoglycaemia, hyperglycaemia, dehydration and acute metabolic complications such as diabetic ketoacidosis. 

“When we fast, the body initially uses stored sources of glucose. Later, it breaks down body fat to use the next source of energy. It is important to keep a tap on the blood glucose levels as the chances are that the blood glucose levels may drop too low during fasting. It is advisable to keep the doctor informed if you decide to fast,” said Dr Rao.

In case the fasting period is longer than 12 hours, then there can be a state of intermittent glycogen depletion and repletion. In practice, most patients, who take their first meal at dawn, are in a state of glycogen depletion by late afternoon, at which point ketogenesis occurs. If a meal is skipped, it can further lead to depletion of glycogen stores and ketosis happens much earlier in the fasting day, said Dr Rao.

“In Type 2 diabetes, people are generally obese and have large abdomens. As the patient gains weight, it gets worse. There is a need to take more insulin, which means more weight is gained, resulting in a vicious cycle. A moderate and properly consulted intermediate fast can be good for diabetic patients for losing weight. It helps control blood glucose, blood pressure, and cholesterol levels. However, fasting should not be done without consulting a doctor,” said Dr Rao.

He said patients should plan a visit to the doctor to assess the risk during fasting. It is important for choosing healthy options while breaking fast, regular monitoring of sugars at home with a glucometer, learning to identify symptoms of high or low sugars, which are crucial during the fast.

DOS FOR DIABETIC PATIENTS DURING FASTING
- Consult your doctor prior to, during and post-fasting
- Include high fibre food in your diet.
- Ensure meals are well balanced with 45 to 50 per cent carbohydrates, 20 to 30 per cent protein and less than 35 per cent fat. Also include a low glycaemic index, high fibre foods that release energy slowly before and after fasting like granary bread, beans, rice and include plenty of fruit, vegetables, and salads. 
- Keep hydrated between sunset and sunrise by drinking water or other non-sweetened beverages.
- Avoid caffeinated and sweetened drinks. Drink plenty of water and sugar-free beverages during non-fasting hours.
- Monitor your blood sugar levels multiple times daily, especially if you are taking insulin.

DON’TS WHEN DIABETIC PATIENTS FAST
- Do not ignore any of the warning signs of low or high blood sugar levels and consult your doctor immediately 
- It is advisable not to continue fasting if the blood sugar level goes below 70 mg/dL or if it goes above 300 mg/dL. Limit the intake of fried food, sweets, and caffeinated drinks. Avoid excessive exercise, especially during fasting hours. In any case, do not stop taking medicines without consulting your doctor 
- Avoid sugary desserts, use small amounts of oil when cooking.

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