Fasting and Diabetes

It's that time of the year again...the time where people call me crazy for wanting to fast. I can agree with everyone that fasting with diabetes can be tricky. After all ... is there anything mixed with diabetes that isn't tricky? 

I've gotten many questions about the purpose of me fasting, why I chose to fast and how I manage it with my diabetes...so let me answer all those questions for you by starting right from the start.  

A Day Of Fasting

As a Muslim one of the 5 pillars of Islam is fasting and that is done once a year for a whole month. It is a commandment from God that if you are in good health and capable of fasting than you should fast. Only those who are ill, pregnant and breastfeeding women, travelling, women in menstruation, or people of old age are exempt of fasting. And while diabetes does fall under the category of illness, meaning diabetics are exempt from fasting...it is ultimately left as a choice between the diabetic and their diabetes team. For this month Muslims around the world fast from dawn to sunset...so if you're in Australia you would fast around 10 hours (5 am to 5pm). However, if you're as lucky as me and live in Canada, you get to fast for 17 hours (4am to 9pm). 

Fasting for long hours without any food or water can be very tricky on a person with diabetes. 

Working on keeping blood sugars stable to avoid any highs or lows are challenging. While highs are somewhat safer as the person will not need to break their fast ...being high for long periods of time makes a diabetic super thirsty. Definitely not a favourable thing if you can't have water. 

Adding on, it can be very hard to keep hydrated. That is certainly a challenge that I am facing. Especially for a person who isn't a fan of water, drinking enough water in such a short period of time is super tricky. Dehydration causes elevated blood sugar levels.

Can You Guess When I Ate?

Another challenge is going on with your normal day. During Ramadan sleep patterns are messed up. (lucky for me mine have always been messed up so nothing changes here lol) Many stay awake until dawn, where they have something to eat, pray and than go to sleep. That is usually around 4am and than they are up for a long day starting at 8am - 9am. This can leave a person feeling very tired as the exhaustion catches up. As for a person with diabetes, studies have shown that reduced sleep has a reaction with elevated blood sugars.

The last challenge is when I break my fast. You can't blame me for eating fast and not giving my insulin time to work like I usually do... this in return causes a big and fast spike which requires plenty of insulin and takes forever to come back down.

So why do I fast despite all the challenges I mentioned above? Well mostly I feel at peace during this month and seem to feel more connected to God. But other than the spirituality and faith reasons...I am no different than my brother, friend and everyone else that fasts. I don't want to stand out because of my diabetes and I don't want to have to explain at every gathering or to every person that sees me eating 'why I am not fasting'. Secondly, ever since connecting with diabetes I've tried not to let it stop me from doing anything I have done in the past and that was certainly one of those things. If 10 year old me can fast than 19 year old me can definitely fast. And lastly I try not to use the 'diabetes card' unless it is needed. I feel healthy and capable of fasting. My diabetes team agrees with that and so do my blood tests and blood sugars. 

Basal Testing

How do I manage my day? That is a another question I often get. A few weeks before Ramadan I start basal testing. That basically means  not eating for 3-4 hours at a time testing blood sugars and adjusting ratios to ensure I avoid lows. I let my diabetes team know so they are on board. When fasting starts I change my dexcom highs and low limits for 4 mmol/l and 8 mmol/l to 5.5 mmol/l and 10 mmol/l  Having my low limit set high gives me time to prevent a low. I usually put on a temp basal or suspend my pump until my blood sugars have risen. Before working out I usually put a temp basal at a 50% reduction, 1hr before working out and suspend my pump while working out...although this decision differs depending on blood sugars before starting my workout. Corrections can be tricky, because too much can cause a low making me break my fast therefore, when correcting blood sugars I give 50% of what my pump suggests or 0.3u if I notice my blood sugar starting to rise. Having an insulin pump and my dexcom has definitely made things easier with managing my blood sugars and avoiding many highs and lows. Just to point out this is how I manage my diabetes while fasting. While suspending my pump to treat a mild low or working out while fasting which can cause dehydration does not sound safe, I listen to my body and make sure it is satisfied throughout the day. To try and combat dehydration I've been drinking green juices, smoothies and adding electrolytes to my water. The combination of these three ways of hydration seem to be working well

Making My Green Smoothie

Pump Suspended at 4pm to 

avoid going low