Diabetes is a common disease that statistically affects 3.9 million people in the UK and has potentially serious complications. It is the most common cause of:
- Blindness in adults
- Kidney problems
- Leg amputations (other than accidents)
- Having diabetes makes you five times more likely to suffer heart attacks and strokes
Not everyone gets Symptoms of diabetes, but below are some of what you can experience
- Rapid weight loss
- Frequent urination especially at night
- Pear drop smell to your breath
- Excessive thirst
If you experience any of these please see your GP.
Pre Diabetes also known as impaired glucose tolerance.
In pre-diabetes (impaired glucose tolerance), your blood sugar (glucose) is raised beyond the normal range. Whilst this raised glucose level is not so high that you have diabetes, you are at increased risk of developing diabetes when you have pre-diabetes. you are also at increased risk of developing conditions such as heart disease, peripheral arterial disease and stroke (cardiovascular diseases). If pre-diabetes is treated, it can help to prevent the development of diabetes and cardiovascular disease. The most effective treatment is lifestyle changes, including eating a healthy balanced diet, losing weight if you are overweight, and doing regular physical activity.
Between 1 and 3 out of every 4 people with pre-diabetes will develop diabetes within ten years, Many people have pre-diabetes (impaired glucose tolerance) and because there are no symptoms, they do not know that they have it. Diabetes UK estimates that around seven million people in the UK have pre-diabetes.
Pre-diabetes (impaired glucose tolerance) develops for the same reasons as type 2 diabetes (see above). There are various things that can increase your risk of developing pre-diabetes. They are the same risk factors as those for type 2 diabetes. They include:
- Being overweight or obese (most people with pre-diabetes are overweight or obese)
- Having a family history of diabetes. This refers to a close family member with diabetes - a mother, father, brother or sister
- Doing little physical activity
- Having other risk factors for cardiovascular disease such as high blood pressure or high cholesterol levels
- If a woman has polycystic ovary syndrome and is also overweight
- If you developed diabetes during pregnancy (called gestational diabetes)
Following a low carbohydrate diet will help you reduce your sugar levels in your blood.
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Ramadan and Diabetes
Ramadan is the Holy Month for Muslims, a time of worship, self-discipline, austerity and charity. During Ramadan, there are alterations to mealtimes and the daily routine, and special traditional foods are eaten.
Fasting is necessary for all healthy adult Muslims, with no food or water consumed between dawn and sunset.
The Qur’an allows you not to fast if you have an illness or medical condition. You could consider donating some money to charity as an alternative means of participating in Ramadan. Muslims with diabetes can be exempt from fasting, but if you really want to fast, make sure you can do it safely. Fasting can cause problems for people with diabetes, as your blood glucose levels are closely linked to your diet, the timings of your meals and your medication.
If you are in any doubt about how you should manage your diabetes while you fast, you should talk to your diabetes care team. There may be circumstances when you will be advised not to fast for health reasons.
Group 1: if you manage your diabetes with diet and exercise
If you manage your diabetes with diet and exercise and don’t take any medication, as long as you continue to be careful with your diet, you can fast safely during Ramadan. If you are overweight, you may lose weight during Ramadan, which will help you improve the way you control your blood glucose levels. The following tips will be helpful:
Divide your daily food into two meals, Sehri and Iftar.
Have some starchy food such as cereals, basmati rice, chapatis or naan at every meal.
Have plenty of fruit, vegetables, dhal and yoghurt.
Eat only small amounts of sweet foods such as ladoo, jelaibi or burfi.
Avoid fatty fried foods such as samosa or pakora.
Stick to low-calorie or ‘diet’ drinks or, better still, water. Drink plenty of fluid.
You may feel tired when fasting during Ramadan, so although it is important that you continue your daily activity and prayer, try to rest at some point in the day.
Group 2: if you manage your diabetes with diet, exercise and tablets
It is important that you follow the same guidelines as for people in Group 1 regarding diet and rest.
The advice for fasting will vary slightly depending on what diabetes medication you take. You may need to adjust your medication, depending on your symptoms and blood glucose levels. You should discuss any changes to your medication with your diabetes care team.
Metformin (Glucophage) or Acarbose
If you take these tablets and feel unwell while you are fasting, you can consider stopping them, reducing the dose or changing the timing of when you take them. If you continue to take them, the largest dose should be taken at Iftar, so that they work when you are eating.
Glibenclamide 2.5 mg, 5 mg
Gliclazide (Diamicron) 40 mg and 80 mg tablets
Gliclazide MR 30 mg
Glimepiride (Amaryl) 1 mg, 2 mg
Glipizide 5–20 mg
Tolbutamide 500 mg
Prandial glucose regulators
Repaglinide (Prandin) 0.5 mg, 1 mg, 2 mg
Nateglinide (Starlix) 60 mg, 120 mg, 180 mg
Sulphonylureas and prandial glucose regulators can cause hypoglycaemia (low blood glucose) when you are fasting, which could make you feel ill. They should not be taken during fasting hours but you may take a dose when you are eating, e.g. at Iftar.
Pioglitazone These do not cause hypoglycaemia (low blood glucose) when taken alone and are usually taken once a day in the morning. If you feel unwell when you are fasting, you may wish to take them at Iftar.
Dipeptidyl peptidase 4 (DPP4) inhibitors, also known as gliptins
Alogliptin (Vipidia) 6.25 mg, 12.5 mg, 25 mg
Linagliptin (Trajenta) 5 mg
Linagliptin + Metformin (Jentadueto) 2.5 mg/850 mg, 2.5 mg/1000 mg
Sitagliptin (Januvia) 100 mg, 50 mg, 25 mg
Sitagliptin + Metformin (Janumet)
Saxagliptin (Onglyza) 2.5 mg, 5 mg
Vildagliptin + Metformin (Eucreas) 50 mg/850 mg, 50 mg/1000 mg
These tablets generally do not cause hypoglycaemia (low blood glucose) on their own. In addition, as they are taken once daily, you can continue to take them as normal, or, if it is easier, you can take them with food, e.g. at Iftar.
SGLT2 (sodium-glucose transporter 2) inhibitors
Canagliflozin (Invokana) 100 mg, 300 mg
Canagliflozin and Metformin (Vokanamet) 50 mg/850 mg, 50 mg/1000 mg, 150 mg/850 mg, 150 mg/1000 mg
Dapagliflozin (Forxiga) 5 mg, 10 mg
Dapagliflozin and Metformin (Xigduo) 5 mg/850 mg, 5 mg/1000 mg
Empagliflozin (Jardiance) 10 mg, 25 mg
Empagliflozin and Metformin (Synjardy) 5 mg/500 mg, 5 mg/1000 mg, 12.5 mg/850 mg, 12.5 mg/1000 mg
These tablets generally do not cause hypoglycaemia (low blood glucose) on their own so you can continue to take them as normal, take a reduced dose or, if it is easier, take them with food, e.g. at Iftar.
Non-insulin injections: glucagon-like peptide (GLP-1)
Exenatide (Byetta) 5 mcg, 10 mcg twice-daily pen injection
Exenatide Extended Release (Bydureon) 2 mg once weekly
Liraglutide (Victoza) 0.6 mg, 1.2 mg once-daily pen injection
Lixisenatide (Lyxumia) 10 mcg, 20 mcg once-daily pen injection
Dulaglutide (Trulicity) 0.75 mg, 1.5 mg weekly injection
Albiglutide (Eperzan) 30 mg weekly injection
Acarbose (Glucobay) 50 mg, 100 mg
These drugs do not cause hypoglycaemia (low blood glucose) on their own so it may be possible to continue to take these as long as you monitor your blood glucose levels closely. They can, however, cause nausea. Whether or not you can continue to take these will depend on your blood glucose levels and symptoms.
If you are in any doubt at all about what to do with your tablets or injections when fasting, discuss it with your diabetes care team.
Testing your blood glucose when taking tablets and fasting
When you take tablets that can cause hypoglycaemia (low blood glucose), it is a good idea to check your blood glucose more often when fasting to make sure that the level is not rising too high (more than 10) or dropping too low (less than 4).
If your results worry you and you are unsure what to do, contact your diabetes care team for advice.
Group 3: if you manage your diabetes by taking insulin (with or without tablets)
It is important that you follow the same guidelines as for people in Group 1 regarding diet and rest.
If you manage your diabetes with insulin, it is vital that you know what to do when fasting to avoid high blood glucose (hyperglycaemia – more than 10) or low blood glucose (hypoglycaemia – less than 4). You must check your blood glucose frequently to make sure that it is staying within normal levels.
In general, you will need much less insulin when you are fasting and will need more during the hours when you are eating. If you do not adjust your insulin regime you will be at risk of hypoglycaemia during fasting hours.
Quick-acting insulins, e.g. Novorapid, Humalog or Apidra, in combination with long-acting insulins (see below) provide a more flexible insulin regime, making it easier to alter the doses and change the timings of your injections. Your diabetes care team may advise you to change to a quick-acting insulin, so that you inject only when you are eating.
Intermediate and long-acting insulin
Intermediate and long-acting insulins, e.g. Lantus, Levemir, Glargine, Humulin I, Insulatard or Degludec, are often used on their own or in combination with quick-acting insulins. The dose of long-acting insulin may need to be reduced if you are fasting.
Pre-mixed insulin, e.g. Novomix 30 or Humalog mix 25 and mix 50, are not usually recommended during periods of fasting. If you do continue to use these insulins, it is likely that you will have to adjust the timing and doses so that you are always taking insulin in conjunction with eating.
You will need to discuss any changes to your insulin with your diabetes care team, so be sure to contact them for advice well in advance of the next Ramadan.
If you have a hypoglycaemic episode (a ‘hypo’) while you are fasting, it is essential that you break your fast otherwise your hypoglycaemia may get worse and you could fall into a coma.
You should always be alert for the following symptoms and ask friends and family to look out for the signs too, as you may not always be aware of them yourself.
You should take some rapid-acting carbohydrate, such as full-fat Coke or four or five chewy sweets. Then take some slow-acting carbohydrate, such as a sandwich or chapati, to keep your blood glucose levels up. Keep checking your blood glucose every ten minutes, and try to work out what caused your hypo:
Was it because you fasted and didn't change your diabetes treatment?
Was it because you were doing exercise or physical activity and not resting?
More information on hypoglycaemia treatment can be found here.
More information from Diabetes UK can be found here.
Muslim Council of Britain website.
Gestational diabetes is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth. It can happen at any stage of pregnancy, but is more common in the second or third trimester. It happens when your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet your extra needs in pregnancy.
Gestational diabetes can cause problems for you and your baby during pregnancy and after birth. But the risks can be reduced if the condition is detected early and well managed.
Long-term effects of gestational diabetes
Gestational diabetes normally goes away after birth. But women who've had it are more likely to develop:
- gestational diabetes again in future pregnancies
- type 2 diabetes – a lifelong type of diabetes
- You should have a blood test to check for diabetes 6 to 13 weeks after giving birth, and once every year after that if the result is normal.
See your GP if you develop symptoms of high blood sugar, such as increased thirst, needing to pee more often than usual, and a dry mouth – do not wait until your next test.
You should have the tests even if you feel well, as many people with diabetes do not have any symptoms. You'll also be advised about things you can do to reduce your risk of getting diabetes, such as maintaining a healthy weight, eating a balanced diet and exercising regularly.
Some research has suggested that babies of mothers who had gestational diabetes may be more likely to develop diabetes or become obese later in life.