Consulting with a doctor for assessment before fasting commences is of utmost importance for a diabetic patient. This helps the patient know his or her risk level before fasting. Assessment can be done a month or two before fasting begins, to give enough time for adjustments to be made so as to have a safe fasting period.

Whether a diabetic patient should fast will be dependent upon factors like:

  • type of diabetes the patient has.
  • type of medication the patient is taking for the condition which include tablets, insulin injections etc.
  • whether the patient’s blood sugar is under control.
  • whether the patient suffers from other complications related to diabetes like kidney disease.


Diabetic patients who can fast  

These include:

  • Prediabetic patients who practice lifestyle modification like eating healthy for the condition and regular exercising.
  • Type 2 diabetic patients who practice healthy lifestyle for the condition, regularly take tablets like metformin to bring their blood sugar level under control and perform daily moderate exercises like brisk walking.

A type 2 diabetes patient who can fast should consult a doctor for adjustment in doses of medication before fasting as there are meal times that will be missed during the fasting period and this can affect blood sugar level. Blood sugar should therefore be well monitored as it can get low during fasting. Frequency of the number of times to test for sugar levels during the day differ from person to person. However, high risk patients who decide to fast like those who use insulin, must check their blood sugar several times during the day. Generally, blood sugar must be tested more frequently during the first three days of fasting.

 Diabetic patients who should not fast (high risk patients) include:

  • Type 1 diabetes patients who take insulin several times to keep their blood sugar under control.
  • Type 2 diabetes patients who take insulin.
  • Women who are diabetic and pregnant.
  • Patients who frequently become hypoglycaemic during the day.
  • Patients who have complication or complications due to diabetes e.g. kidney disease, nerve damage, heart disease and stroke.

Some causes of complications in diabetic patients during fasting

The awareness of the signs of complications during fasting as a diabetic patient and when to discontinue fasting are very important. These complications may be due to either high blood sugar, low blood sugar or dehydration caused by any of the following:

  • Medication not properly adjusted before the patient started fasting.
  • Consuming inadequate quantity of food causing low blood sugar.
  • Too much exercise or activity causing low blood sugar.
  • Being sick due to infection or other ailments causing high or low blood sugar.
  • Irregular intake of medication causing high blood sugar.
  • Dehydration which makes you feel thirsty, tired and dizzy due to the long period of not drinking water. High sugar and the intake of some medications can also cause dehydration.

The signs of complication include mental confusion, anxiety, feeling dehydrated, fast heart rate and profuse sweating.

When to discontinue fasting

It is advisable to discontinue fasting when signs of complications show up due to high blood sugar, low blood sugar or dehydration, and if unwell and cannot continue fasting. It is important that one is aware of his or her own signs of complications and to consult a doctor when experiencing any of these signs. Completely discontinuing with fasting when blood sugar is below 4 (3.9 and below) is strongly recommended.


What to do when blood sugar goes low

When blood sugar goes below 4, any of the following measures can be taken immediately: Suck 3-4 sweets; or take half a glass of juice; or drink half a can of regular soft drink like coke or sprite; or drink a sugar drink made by dissolving 4 teaspoons of sugar in water. After doing one of the above, check blood sugar again to make sure it is above 4, then break the fast and eat some food.


When blood sugar is high

High blood sugar may cause one to feel hungry and thirsty like in dehydration and may also cause blurred vision and tiredness. When this happens, test blood sugar level and stop fasting if it is above 15. Drink enough water, eat and take medication and then consult with a doctor who will advise on the next step to take with regard to the fast.


Other important steps to follow 

  • Drink adequate quantity of water when dehydrated. 2 litres of water or 8 glasses of water is adequate. More water can be drunk if you sweat a lot or if active.
  • Avoid being exposed to excessive heat and sun to avoid dehydration.
  • Consult a doctor if feeling unwell.
  • Take medication as prescribed by the doctor


Diet for a diabetic patient when fasting

Follow the healthy food plate which consists of a variety of foods in their correct proportions . This consists of:

  • Half of the plate being filled with different colours and varieties of vegetables and fruits, with a larger proportion of vegetables.
  • One-fourth of the plate filled with healthy starchy foods like brown rice, millet, oats, whole wheat and whole wheat pasta.
  • One-fourth plate filled with proteins like fish, beans, nuts and poultry. Limit intake of red meat. Avoid processed meat like luncheon meat and sausages.
  • Use healthy oils from plants like olive oils, canola oil and sunflower oil.
  • Consume half the required amount of sugar nondiabetic people consume per day which is half of 50g (25g), with 1 teaspoon being 4g. Avoid sugary drinks.


Other healthy habits include limiting milk and dairy products like cheese, engaging in moderate intensity exercise like brisk walking for half an hour 5 times a week, maintaining good body weight which is a BMI of 18.5 kg/m2 to 24.9kg/m2 and healthy abdominal fat.

After the fasting period, the medication dosage taking during fasting must be changed to the normal dosage. Regular consumption of healthy meals and the general adoption of a lifestyle suitable for the condition cannot be overemphasized.  Finally, regularly testing blood sugar to ensure that it is at a  healthy level is of utmost importance.

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