Total Diet Replacement during Ramadan

There are several reasons that exempt Muslims from fasting during the month of Ramadan. Health conditions such as Diabetes falls into these exemptions. However, many Muslims with Diabetes do decide to fast. It is important to know that this is your decision to make and there are measures you can take to ensure you are safe during Ramadan:

• Monitor your blood glucose
• Attend your medication reviews
• Always carry hypo treatment
• Eat the right foods at Suhoor (meal before sunrise) and Iftaar (meal after sunset)
• Stay hydrated when you can
• Follow food guidelines for your programme
• Talk to family, friends and your community
• Care for your mental health
• Get enough sleep and daily activity

When we fast for prolonged periods of time our blood glucose levels can lower. Talk to your healthcare team if you are planning to fast and they can help you in making any changes necessary. If you are not taking medications for Diabetes, then you do not have a risk of hypo – our bodies will not let our blood glucose levels drop to dangerous levels.

Yes, if your blood glucose is managed well. Therefore, having a conversation with your healthcare team is important when you are considering fasting. Monitoring your blood glucose can allow you to complete Ramadan safely. If you feel unwell or experience symptoms of a hypo, it must be treated and breaking your fast would be advised. It is okay to break your fast when you are feeling unwell or your blood glucose drops below 4mmol/l. The days that you miss, or break can be made up after Ramadan or during the winter months when the days are shorter and may be safer for you to complete.

Talk to your healthcare team to make sure you are in good health and that your Diabetes is managed well before you start to fast. Make sure that you know when you should/shouldn’t be fasting and you are comfortable with knowing when you should break your fast (i.e. if hypo – See PAP).

Understanding the added risk involved when fasting with Diabetes can help you to make safe decisions during Ramadan. Should you decide to fast it may be useful to take a day by day approach, understanding when your body is reacting poorly to a fasting state and deciding to break your fast. Remember that during this time there are many other ways to enjoy Ramadan. If you are not well enough to fast, then you gain the benefits of Ramadan by:

• Reading the Quran
• Listening to lectures 
  
• Getting involved in charity (this doesn’t have to be financial, your time is just as valuable) 
  
• Praying and making Dua

Monitoring your blood glucose and speaking to your healthcare team can help you stay safe during Ramadan. Your healthcare team will be able to help you understand any changes you may need to make with medication timing or dosage. 

Checking your blood glucose levels regularly during Ramadan is essential to ensure you are observing the fasting month safely. Checking your blood glucose levels does not break your fast. Check your blood glucose levels if you are feeling unwell during fasting. If you are experiencing a hypo (less than 4mmol/l), it is important to break your fast so you can treat your blood glucose.

Outside of Ramadan you may check your blood glucose less regularly but frequently checking during Ramadan is important.

Informing your healthcare team that you are deciding to fast with Diabetes would allow them to advise you on best practice. We suggest that you also discuss fasting with Diabetes with family members/ members of your household. You can use your PAP to help them understand what a hypo is so they can also be aware of how to support you. This will help you to manage your blood glucose levels while fasting.

Fasting means refraining from food and water throughout the day. However, it is important to consider what to eat at Suhoor and Iftaar. It is important to continue following the TDR programme, consuming your 4 products when you can, during Suhoor and Iftaar. If you are planning to break fast with dates, remember that this is off the plan, but you may wish to do this for religious purposes. Just make sure you don’t overindulge here.

You may be dehydrated when breaking your fast so drinking plenty of water will help. It is traditional to break fast with dates and a drink of milk or water. To follow the programme we would suggest using water, however, your shake/soup products are milk based so you may feel comfortable breaking fast with a shake/soup.

It can be difficult to consider adjusting your usual Ramadan routine, speaking to family and friends can help so they understand and can support your choices. It may also be helpful to consider the timings of when you will consume your products for your Suhoor and Iftaar.

If you are at the food reintroduction stage of the programme or about to start it, navigating this stage during Ramadan can be tricky. When creating meals consider the portion plate and your portion sizes (See PAP), make sure you eat lots of vegetables and salad as well as:

• Lean protein 
  
• Wholegrain carbohydrates and fruit 
  
• Minimise foods in high in saturated fats 
  
• Minimise foods high in refined sugar 
  
• Use small amounts of cooking oils and avoid fried foods 
  
• Plenty of sugar free fluid

Once it comes to the end of the fasting day, try not to overindulge. Remember healthy portion sizes and use your PAP to guide you. We can often overindulge on large portions and sweet foods when we break our fast. This can increase the risk of hyperglycaemia (high blood glucose). Try not to see Ramadan as fasting and feasting. Eating a small amount at Iftaar and then again, a few hours later can help reduce the risk of this occurring.

During Ramadan it is easy to become tired and not get up to have an adequate Suhoor. If you do decide to fast, it is important that you are disciplined in getting up and having Suhoor; a product and lots of water. Similarly, it is important to incorporate your shake/ soup products with Iftaar. For example, have a soup/shake product at Iftaar and a few hours later have another product. It may take a few days to figure out what works best for you.

Exercise is an important part of everyday life and this doesn’t have to stop because we are fasting. During Ramadan, having lower energy levels and becoming dehydrated towards the end of the day is quite normal. Having Diabetes can add a small risk to this (have your medications monitored regularly). Light to moderate exercise during Ramadan such as walking, is good for our physical and mental wellbeing. Take this day by day; consider the first few days of Ramadan as adjusting to fasting. If you feel well and feel comfortable to go for a short walk that’s great.

Taraweh (night prayers) can be long and taxing on the body. During Taraweh, make sure you are staying hydrated. If you feel unwell or overly tired you can take a break or chose to sit and continue Taraweh. Taraweh is not a compulsory prayer – remember to listen to your body and take rest when needed.

Drink plenty of water at Suhoor and Iftaar. Any sugar free drinks are also good options to help you rehydrate after a day of fasting. We often deprive ourselves of sleep during Ramadan so we can stay up and pray Taraweh so make sure you’re getting enough sleep when you can. Lack of sleep can lead to feeling hungry and not being able to focus as you may want to. This can mean that we pay less attention to what we are eating or are less likely to engage in activity or take care of ourselves properly.