Intermittent Fasting and Safe Fasting for Diabetes
Religious fasting days such as Yom Kippur should be approached with caution by a diabetic (Fasting is an important spiritual aspect of many religions, such as Islam, Hinduism and Judaism and for some Christians). If your condition is entirely controlled by dieting, or even by diet and oral medication, then you should not have any problems. Although, it may be a good idea to hold out on taking your pill until right before the evening meal that breaks the fast. The problem that occurs falls within insulin dependent diabetics.
It's not very wise to fast if you're an insulin dependent diabetic. Fasting for you is much trickier and actually dangerous. It may be best to alter the tradition than to have a medical emergency.
If fasting is something that you just don't want to give up, that's fine, as it is possible, just make sure you take precaution and do it right. Lets say you usually require 10 regular and 30 units of intermediate insulin when you wake up. During a fasting day, you would take 0 insulin before breakfast, and skip breakfast and lunch. Now if you go through your day without any negative symptoms, then check your blood sugar right before supper, and if it's high, don't take your usual morning dose. Take more regular than you normally would, and less intermediate. For instance, you may take 20 regular, and 20 intermediate. You do this to compensate for the higher than average blood sugar level, but you don't want it lasting into the following day.
Suppose you do run into some symptoms after skipping breakfast and lunch, as well as your morning insulin. You may get high sugar and acidosis, more frequent urination, thirst, etc. In this case you should not continue fasting until dinner. Break the fast, start eating, and take your insulin. In this case as well, you should increase your regular intake and decrease your intermediate intake. Remember, you may want to follow your religion by fasting, but seriously risking your health and/or life is not necessary.
If you take oral medications for your diabetes the night preceding your fast, then you should take only half of your regular dosage. This is because you will likely have excess insulin as you skip meals the next day.
It's not very wise to fast if you're an insulin dependent diabetic. Fasting for you is much trickier and actually dangerous. It may be best to alter the tradition than to have a medical emergency.
If fasting is something that you just don't want to give up, that's fine, as it is possible, just make sure you take precaution and do it right. Lets say you usually require 10 regular and 30 units of intermediate insulin when you wake up. During a fasting day, you would take 0 insulin before breakfast, and skip breakfast and lunch. Now if you go through your day without any negative symptoms, then check your blood sugar right before supper, and if it's high, don't take your usual morning dose. Take more regular than you normally would, and less intermediate. For instance, you may take 20 regular, and 20 intermediate. You do this to compensate for the higher than average blood sugar level, but you don't want it lasting into the following day.
Suppose you do run into some symptoms after skipping breakfast and lunch, as well as your morning insulin. You may get high sugar and acidosis, more frequent urination, thirst, etc. In this case you should not continue fasting until dinner. Break the fast, start eating, and take your insulin. In this case as well, you should increase your regular intake and decrease your intermediate intake. Remember, you may want to follow your religion by fasting, but seriously risking your health and/or life is not necessary.
If you take oral medications for your diabetes the night preceding your fast, then you should take only half of your regular dosage. This is because you will likely have excess insulin as you skip meals the next day.
#Intermittent Fasting May Put Type 2 Diabetes in Remission, Small Study Finds
Could restricting your diet for a couple of days a week put type 2 diabetes in remission? That’s the controversial claim scientists of a small new study are making as they fan the fire around a diet fad known as intermittent fasting. But many health professionals, including those at the American Diabetes Association, argue that the approach can be dangerous for people with diabetes, whose bodies cannot control their blood sugar without careful diet, medication, and sometimes insulin management.
In the study, published October 9, 2018, in the journal BMJ Case Reports, intermittent fasting, in which eating is limited during certain times of the day or week, reportedly helped three middle-aged men with type 2 diabetes lose weight, get off their insulin, and reduce or get off their oral medication.
“The problem is we don’t treat diabetes as a dietary problem; we treat it with a lot of drugs, and that never addresses the root problem of the diabetes,” says principal investigator Jason Fung, MD, a kidney specialist at Scarborough and Rouge Hospital in Toronto, Canada, and author of The Complete Guide to Fasting,and The Obesity Code, a 2016 book thought to help popularize intermittent fasting.
The Effects of Intermittent Fasting on Weight and Blood Sugar
About 90 percent of people with type 2 diabetes are obese or overweight, according to the Obesity Society. Weight loss is a known treatment for type 2, which affects the majority of the 30.3 million people with diabetes, as it helps people with the disease reduce insulin resistance and absorb blood glucose more effectively. According to the Centers for Disease Control and Prevention (CDC), being overweight makes it harder to control diabetes and is a risk factor for diabetes-related health complications.
The hallmark of type 2 diabetes is insulin resistance, a condition in which the cells, muscles, and liver can’t effectively absorb glucose (blood sugar). This causes hyperglycemia (high blood sugar), and in serious cases requires medication, such as Glucophage (metformin) and insulin, to lower.
Ordinary calorie restriction through any diet can lead to weight loss and make it easier to manage blood sugar. Intermittent fasting is thought to go a step further by lowering serum insulin, which triggers the body to burn stored sugar, called glycogen, along with fat, in the absence of glucose from food, Dr. Fung says. These processes (called glycogenolysis and lipolysis, respectively) can temporarily lower blood sugar and cause weight loss.
How Intermittent Fasting Affected Men in the Study
In the study, Fung and his team randomly recruited three men, ages 40 to 67, with type 2 diabetes, who also had high cholesterol and high blood pressure. At the start of the study, the authors recorded the participants’ vitals, including their A1C (a three-month average of their blood sugar levels), their fasting blood glucose levels, their waist circumference, and their weight. All three men were on insulin and oral medication.
The men took a six-hour educational course on diabetes and intermittent fasting prior to fasting. For the experiment, one man fasted for 24 hours three days per week, and the other two alternated their fasting days throughout the week. On fast days, they ate one low-calorie meal in the evening, and drank low-cal beverages, such as water, coffee, tea, and broth. The authors encouraged participants to opt for low-carb on the eating days.
Two times per month, Fung and his colleagues observed the participants, and adjusted their insulin and medication to help prevent episodes of hyperglycemia and hypoglycemia (low blood sugar).
Eighteen days into the study, all three men lost 10 to 18 percent of their body weight, trimmed their waist circumferences, no longer had to take insulin, and reduced their oral medication. (Two of the three men completely got off their medication during this time frame.)
“In all cases, their blood sugar was actually better at the end than the beginning despite not taking medication, which tells you the diabetes is reversing,” says Fung, adding that the participants maintained their improved vitals for about a year total.
Why It’s Too Soon to Recommend Intermittent Fasting to Treat Type 2 Diabetes
One of the reasons intermittent fasting is so controversial is that there are limited large-scale human studies that prove it’s safe and effective in humans long term, says Robert Gabbay, MD, PhD, chief medical officer at Joslin Diabetes Center at Harvard Medical School in Boston.
One such study, published in July 2018 in the Journal of the American Medical Association, found that intermittent fasting was no better at improving type 2 diabetes participants’ blood sugar levels than regular caloric restriction after one year. Previous studies on mice suggest intermittent fasting may improve memory, reduce disease risk, and aid with weight loss, according to an article published in June 2013 in the journal CMAJ, but, as Dr. Gabbay points out, “That doesn’t always translate to people.”
Yet Gabbay says preliminary human studies with positive results, like this week’s in BMJ Case Reports, suggest the diet is worthy of further study in a larger population over a longer period of time. For now, he cautions people with diabetes, especially those on insulin and sulfonylureas to lower their blood sugar, against trying intermittent fasting before speaking with their healthcare provider.
Fung agrees, saying medical supervision is key when fasting and managing diabetes. “If you’re on medication, you have to talk to your doctor because they’re the ones who are going to guide you. We were the ones who guided these patients,” Fung says.
A Look Ahead at Possible Intermittent Fasting Research
Because of the small size of the current study and the potential health risks of intermittent fasting (high and low blood sugar, among them), Gabbay says it’s too soon to officially recommend intermittent fasting for diabetes treatment. He is also skeptical about the sustainability of intermittent fasting.
“The goal is to really have sustained weight loss, and for some, this (intermittent fasting) might be a difficult long-term pattern of eating, which is what one really needs to do for maintaining weight,” Gabbay says.
Fung hopes to conduct a longer-term, large-scale study, but he isn’t sure when his team would receive approval. “We’ve had to fight to get even this published,” he says.
Fung argues that institutional medicine considers fasting harmful despite its regular use in medicine (prior to colonoscopies, for example) and its use in certain religions, such as during Ramadan in Islam. But that may be different in the future.
“Public interest in fasting has sort of exploded,” Fung says, “and I’m hoping that starts to change these entrenched attitudes that fasting is intrinsically harmful to us.”
#Safe Fasting for Diabetes: Tips for Safe Fasting
In this article, Dr Daphne Su-Lyn Gardner, Senior Consultant, Department of Endocrinology, Singapore General Hospital (SGH), a member of the SingHealth group shares some guidelines for safe fasting during Ramadan when you have diabetes.
Before you fast
- Know that there is no compulsion to fast when you’re not healthySurah Al Baqarah Verse 184 - 185 provides a clear guide that fasting during Ramadan is not compulsory if you have chronic diseases, or where fasting endangers or is harmful to your life (e.g. if you’re on insulin, have renal failure, or are pregnant).You can make contributions to the poor or needy in lieu of fasting during Ramadan.
- Make the decision to fast with the doctor treating your diabetes 2 months before Ramadan
- How to fast safely
- Whether adjustments to your diabetes medications may need to be made beforehand.
- Have a trial run of fasting before Ramadan
- Don’t skip Sahur (your pre-dawn meal)
- Drink 8 glasses of sugar-free fluids
- Monitor your blood glucose levels when you are fasting
- Check for high blood glucose, low blood glucose levels or severe dehydration
- Signs you should stop fasting
- Blood glucose < 4.0 mmol/L during fasting
- Blood glucose > 16 mmol/lL
- Feelings of tremors
- Sweating
- Palpitations
- Hunger
- Dizziness
- Confusion
- Dizziness (feeling faint)
- Confusion
- Break your fast promptly and eat in moderation
Breaking of fasting (berbuka) should not be delayed. Try not to go overboard when you buka puasa!
It is important to discuss fasting with your doctor up to 2 months before Ramadan as you will need to know:
Do not self-adjust or stop medications on your own.
A "trial run" of fasting before Ramadan (i.e. Puasa Sunat) may be done to identify possible problems during fasting for Ramadan. Please discuss this with your doctor.
During your fast
You must not skip your Sahur (pre-dawn) meal. Should you miss your Sahur meal, you should not fast. Try to eat adequately for Sahur.
Try to drink adequate fluids (choose sugar-free fluids) during Sahur and Iftar (sunset-meal) to replenish fluid loss during the day. Aim for 8 glasses a day.
Self-monitoring of blood glucose during fasting is allowed during Ramadan. In fact, it is necessary for a successful fast.
You must be able to recognise when you have high blood glucose levels, low blood glucose levels or severe dehydration.
You MUST terminate your fast immediately if you encounter these problems. Skipped fasting days can be replaced in the future.
Blood glucose levelsAfter your fast
References:
1. Intermittent Fasting May Put Type 2 Diabetes in Remission, Small Study Finds: https://www.everydayhealth.com/type-2-diabetes/diet/intermittent-fasting-helps-reverse-type-2-diabetes-men-study/
2. Diabetes and Ramadan: 9 Tips for Safe Fasting: https://www.healthxchange.sg/diabetes/living-well-diabetes/diabetes-ramadan-tips-safe-fasting
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