Humza Khizer

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Ismail Munir

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The Foot Care Guide For Diabetic Patients

Introduction

Diabetes foot problems are quite common as, according to the American Diabetes Association, 1 in 5 people with diabetes seek hospital care for it<a href="#accordion">[1]</a>. However, that doesn&#39;t mean everyone with diabetes has diabetic feet. 
&nbsp;

You won&#39;t succumb to diabetic feet if you give your feet all the attention they deserve. It&rsquo;s all the more imperative if your blood sugar levels are continually out of range.&nbsp; 
&nbsp;

In short you need to be proactive while taking care of your feet to avoid diabetic foot or any other complications. 
&nbsp;

Understanding the Foot Care for Diabetic Patients

To understand the correlation between diabetes and foot problems, you first need to have a clear idea about what diabetes really is.&nbsp; 
&nbsp;

<h5>Understanding Diabetes&nbsp;</h5>

Diabetes mellitus, or diabetes for short, is a metabolic disorder that causes high blood sugar levels, which is referred to as hyperglycemia.&nbsp; 
&nbsp;

The reason for diabetes is either absolute or relative deficiency of insulin, or&nbsp; insulin resistance. Insulin is the hormone released by pancreas that helps to maintain a normal level of the blood glucose levels by ensuring glucose uptake in the liver and muscles after a meal.&nbsp; 
&nbsp;

There are 3 different types of diabetes:

1. Type 1 Diabetes Mellitus: This type of diabetes has an autoimmune basis, which means that the body&#39;s own immune cells start attacking the pancreas resulting in absolute deficiency of insulin. The reason behind this autoimmune destruction of cells in the pancreas that produce insulin remains unclear<a href="#reference" target="_blank">2</a>. This type of diabetes affects both children and young adults.

2. Type 2 Diabetes Mellitus: Almost 90-95% of individuals with diabetes have this type of diabetes. It occurs when cells in the body become unresponsive to insulin and the sugar levels peak in the blood resulting in hyperglycemia<a href="#accordion">[2]</a>. 
&nbsp;

3. <a href="https://merisehat.pk/disease/diabetes-gestational">Gestational Diabetes</a>: Some women experience this type of diabetes during pregnancy. Their placenta makes hormones that block insulin from functioning<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

If left untreated, all three types of diabetes result in blood sugar levels beyond the normal range, which ultimately damages multiple sites in the body like the kidneys, eyes, nerves, and other organs<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

Some common symptoms of diabetes include<a href="#accordion">[2][3]</a>: 
&nbsp;

<ul>
	<li>Increase in thirst&nbsp;</li>
	<li>Increase in hunger&nbsp;</li>
	<li>Increase in frequency of urination&nbsp;&nbsp;</li>
	<li>Weight loss (individuals with gestational diabetes would have increased weight gain during pregnancy)</li>
	<li>Blurry vision&nbsp;</li>
	<li>Sores that heal slowly or do not heal&nbsp;</li>
	<li>Fatigue&nbsp;</li>
	<li>Numbness or tingling in hand or feet&nbsp;</li>
	<li>Dry or itchy skin 
	&nbsp;</li>
</ul>

Now back to the initial question: how can diabetes cause foot problems? So, diabetes damages the nerves, a condition called diabetic neuropathy. As a result, you may experience pain, tingling, and burning sensation in your affected foot. If the nerve damage is extensive, you may feel nothing at all.&nbsp; 
&nbsp;

While the idea of having an area of skin being pain free may sound great, not being able to have any sensation in any region of your body is far from great. The dangers associated with not being able to sense anything are so serious that it can even cost you losing the affected part through amputation, that is, surgically removing the affected limb. 
&nbsp;

As an individual with diabetic neuropathy, you may not feel a stone or pebble underneath your sole; you won&rsquo;t even feel a blister or if your foot&rsquo;s sore. When these lesions are not treated early on, they can either become the portal of entry for bacteria and other microorganisms causing infection or they can result in ulcer formation due to delayed healing of the skin<a href="#accordion">[4]</a>. 
&nbsp;

Slow healing in diabetic individuals is because the blood vessels supplying the periphery become very narrow which reduces the amount of blood flowing in the leg and foot. This impedes the healing process and infections of the feet often take too long to heal or at times may not heal at all. When an infection doesn&#39;t resolve, it progresses to gangrene (death of a body tissue due to inadequate blood perfusion or due to a serious bacterial infection)<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

Once gangrene or ulcers form in the foot, treatment&nbsp; options include removing the dead tissue and treating existing infections. In extreme cases amputation of the involved part, such as the toe, foot, or part of the leg is the only option<a href="#accordion">[4]</a>.

Therefore, in order to prevent the loss of a part of your limb, precautions should be taken and foot care needs to be maximized. Controlling blood sugar levels is the only way to prevent diabetic foot<a href="#accordion">[4]</a>. In case a foot problem develops, a foot specialist or a podiatrist needs to be consulted immediately<a href="#accordion">[4]</a>. 
&nbsp;

Nerve damage eventually leads to diabetic foot if not treated. The following risk factors increase the risk of developing diabetic neuropathy<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>High blood sugar levels that are difficult to manage</li>
	<li>Having a long history of diabetes with blood sugar levels beyond normal ranges</li>
	<li>Being overweight</li>
	<li>Having hypertension (increased blood pressure</li>
	<li>Having high levels of cholesterol</li>
	<li>Being more than 40 years of age 
	&nbsp;</li>
</ul>

There are some measures that you can take to prevent nerve damage<a href="#accordion">[3]</a>:&nbsp;

<ul>
	<li>Maintain healthy blood sugar levels&nbsp;</li>
	<li>Quit smoking since smoking reduces the blood perfusion to the feet</li>
	<li>Use medications as prescribed by the doctor&nbsp;</li>
	<li>Become physically active&nbsp; 
	&nbsp;</li>
</ul>

You need to be consistent with your foot care regimen as it is the only way to prevent foot problems in diabetes. There&#39;s no denying that managing diabetes can get quite overwhelming with trying to maintain your blood sugar levels, going for doctor&#39;s appointments, taking medications, staying active along with eating healthy; and there is a chance that your feet get neglected in the process. 
&nbsp;

However, incorporating foot care into your daily routine will help reduce the risk of developing diabetic feet<a href="#accordion">[3]</a>. Remember, persistence is the key!&nbsp;

Here&#39;s a list of tips that you can follow to ensure that your feet stay healthy: 
&nbsp;

<ul>
	<li>
	<h5>Inspect Your Feet Daily</h5>
	</li>
</ul>

You need to regularly check your feet for any signs of bruises, scar marks, blisters, swelling, sores, calluses, or any change in color of the skin or nail. You can use a mirror to inspect the part of your feet that isn&#39;t visible to you or, if you don&#39;t find it convenient, ask a family member to help you or consult a doctor<a href="#accordion">[3]</a>. The earlier you detect any sore or blister, the easier it is to treat and vice versa.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Don&#39;t Walk Barefoot&nbsp;</h5>
	</li>
</ul>

Always wear slippers at home and shoes outdoors and never walk barefoot even in your house. This is to prevent injuries to the feet. Moreover, make sure that your shoes have no pebbles or any other object that can cause any injury to your feet<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Wash Your Feet Daily With Warm Water&nbsp;</h5>
	</li>
</ul>

Do not use hot water to wash your feet as it will cause skin&nbsp; dryness; instead, use warm water. Also, don&#39;t soak your feet. Just wash them properly and dry them right after<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Moisturize Your Feet</h5>
	</li>
</ul>

Diabetic individuals, especially those who have dry feet, are no strangers to cracks on their feet. The trick is to keep your feet moistened. However, make sure not to apply lotion or moisturizing cream between the toes as it can result in infection<a href="#accordion">[3]</a>&nbsp;and keep the application limited to the heel of the foot.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Choose The Right Shoes&nbsp;</h5>
	</li>
</ul>

Wear shoes that are the right size, not too tight or too loose. It would not only be difficult to walk, but would also increase the chances of developing foot problems. Most importantly, make it a habit to wear socks with your shoes<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Properly Trim Toenails</h5>
	</li>
</ul>

Try to cut your nails gently straight across and smooth them with a nail file. Avoid cutting your nails too deep as it may cause a break in the skin and become a space for an infection to set in<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Keep The Blood Flowing&nbsp;</h5>
	</li>
</ul>

To maintain perfusion in the feet, put your feet up while sitting and don&#39;t stand or hang your legs for too long. This is also for women with gestational diabetes as they need proper perfusion in their lower limbs (leg area). Wiggle your toes multiple times in a day to maintain perfusion<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Do Not Miss Your Doctor&#39;s Visit&nbsp;</h5>
	</li>
</ul>

Visit your doctor every year or as scheduled for your diabetes. Get your feet properly examined by a feet specialist, more so if your healthcare provider is suspecting diabetic neuropathy. 
&nbsp;

Stay vigilant and if you notice any of the symptoms listed below, consult a healthcare provider immediately to either treat or prevent diabetic foot<a href="#accordion">[3]</a>: 
&nbsp;

<ul>
	<li>Pain in the legs and cramping in the thighs and calves during physical activity&nbsp;</li>
	<li>Inability to sense temperature, pain, or touch over the skin of your foot&nbsp;</li>
	<li>Tingling, painful, and burning sensation in your feet&nbsp;</li>
	<li>Dry skin with cracks</li>
	<li>Thick, yellow toenails&nbsp;</li>
	<li>Signs of fungal infection, such as athlete&#39;s foot&nbsp;</li>
	<li>Any sign of sore, blister, or ulcer anywhere on the foot 
	&nbsp;</li>
</ul>

Conclusion

Diabetes is a very common metabolic disorder and it is associated with a constellation of signs and symptoms. Moreover, the damage caused by diabetes is also widespread as it involves many organs of the body. Diabetic neuropathy affecting the foot is another dreaded complication of diabetes that can cause the diabetic individual to lose sensation over the affected area. It can progress to diabetic foot, which can result in amputation and loss of limb. Optimization of feet care and maintenance of healthy blood sugar levels can prevent the development of this condition.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Diabetic foot is one of the common complications of diabetes yet the most dreaded.</li>
	<li>Diabetes causes nerve damage in the peripheries and this is often due to high blood sugar levels that are not managed.</li>
	<li>Nerve damage causes the foot to lose sensation, and blisters, sores, or minor injuries go unnoticed; it&rsquo;s dangerous because these points can become the site of entry for bacteria and result in infection.&nbsp;</li>
	<li>Infection in diabetic foot is often difficult to treat which then progresses to gangrene and ulceration</li>
	<li>Amputation remains the last resort to protect the infection from progressing throughout the body.</li>
	<li>Maintaining normal blood sugar levels and adopting a healthy foot care regimen are the only ways to prevent diabetic foot.&nbsp;</li>
</ul>

[1] Diabetes Foot Care. WebMD. es/caring-feet. Published 2022.

[2] Watson S. Diabetes: Symptoms, Causes, Treatment, Prevention, and More. Healthline.

[3] CDC.

[4] Problems D, Health N. Diabetes & Foot Problems | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases.

Nawal Adnan

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Checking Sugar While Fasting!

You know what they say &ndash; breakfast is the most important meal of the day. But what about when you&#39;re fasting? Well, in that case, your regular breakfast time is your cue to check your blood sugar level! 
&nbsp;

This is especially important if you&rsquo;re a <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetic</a>. Fasting can cause your blood sugar levels to fluctuate, triggering complications such as hypoglycemia or hyperglycemia. Hence, monitoring&nbsp; blood sugar levels while fasting can help your doctor to adjust your treatment plans as needed. 
&nbsp;

So, go get your glucometer ready and let&#39;s dive into the world of checking sugar while fasting! 
&nbsp;

According to the International Diabetes Federation (IDF), an estimated 537 million people worldwide were living with diabetes in 2021<a href="#accordion">[10]</a>.

Also, diabetes was the ninth leading cause of death globally in 2019 and accounted for approximately 6.7 million deaths worldwide in 2021<a href="#accordion">[10][11]</a>.The IDF projects that the number of people living with diabetes will increase to 643 million by 2030 and 783 million by 2045<a href="#accordion">[10]</a>.

In Pakistan, diabetes affects approximately 26% of the population<a href="#accordion">[12]</a>.&nbsp;It is a major cause of morbidity and mortality in Pakistan, with a high prevalence of complications such as diabetic retinopathy, neuropathy, and nephropathy<a href="#accordion">[12]</a>.

&nbsp;

<h5>What Is Blood Sugar Level?</h5>

The term &quot;blood sugar level&quot; describes the amount of glucose in the blood. Glucose is a form of sugar that is the main fuel for the body&#39;s cells. When glucose levels spiral out of control, it can result in two major health issues &ndash; diabetes and metabolic syndrome. 
&nbsp;

<h5>What Is Fasting Blood Sugar Level?</h5>

The quantity of glucose in the blood after a period of fasting is known as the fasting blood sugar level. The test can help you get a timely intervention, especially if you&rsquo;re prediabetic as you&rsquo;ll be able to make lifestyle adjustments to delay the onset of diabetes. 
&nbsp;

<h5>Is It Really Important?</h5>

There are various reasons why it&#39;s crucial for you to check your fasting blood sugar levels: 
&nbsp;

<ul>
	<li>It determines whether your diabetic medication is effective or not. If your fasting blood sugar levels are regularly high, your doctor will adjust your prescription.</li>
	<li>Monitoring your blood sugar levels before a fast helps spot patterns. For instance, if the recorded fasting blood sugar levels are regularly high post-Iftar, it&rsquo;s an indication that you need to change those meals.</li>
	<li>Your doctor can assess the risk of developing diabetic problems, like consistently high fasting blood sugar levels present with an increased risk of cardiovascular disease, neurological damage, and renal disease.</li>
</ul>

This is why your blood sugar levels need to be just right. 
&nbsp;

Normal Blood Sugar Range

According to the American Diabetes Association:

<ul>
	<li>Fasting blood glucose range: 70-99 mg/dL</li>
	<li>2 hours after a meal: less than 180 mg/dL</li>
	<li>A1C level: less than 5.7% 
	&nbsp;</li>
</ul>

However, these blood sugar levels are affected by various factors, including age, weight, and general health. 
&nbsp;

A fasting blood sugar level of 126 mg/dL or greater is considered a cutoff point to identify diabetes. Consult your doctor immediately if you experience symptoms such as frequent urination or excessive thirst, and you have a fasting blood sugar of 126 mg/dL at least.

&nbsp;

NOTE: Remember diabetes is not always indicated by a single high fasting blood sugar level. A second blood sugar test, such as an oral glucose tolerance test or a hemoglobin A1C test, is typically ordered by doctors to confirm the diagnosis. 
&nbsp;

Checking your blood sugar is an easy procedure that can be carried out either at home or at a doctor&#39;s office: 
&nbsp;

1.&nbsp;&nbsp;&nbsp;&nbsp; Wash your hands properly with soap.

2.&nbsp;&nbsp;&nbsp;&nbsp; Place the blood sugar test strips into the glucometer.

3.&nbsp;&nbsp;&nbsp;&nbsp; Use a lancet to prick your finger.

4.&nbsp;&nbsp;&nbsp;&nbsp; Place the blood drop against the test strip in the glucometer.

5.&nbsp;&nbsp;&nbsp;&nbsp; The glucose meter will show your blood sugar level within seconds.

&nbsp;

<h5>Significance Of Fasting Blood Sugar Levels</h5>

High levels of your fasting blood sugar indicate that the body is either not producing enough insulin or not utilizing it well. This may lead to diabetes and other health issues. On the other hand, low fasting blood sugar levels will cause confusion, vertigo, and weariness. 
&nbsp;

Hyperglycemia and Hypoglycemia

Fasting blood sugar levels must be measured to diagnose hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) in diabetics. 
&nbsp;

High blood sugar levels in diabetics can result in a variety of symptoms, including increased thirst, frequent urination, impaired vision, lethargy, and sluggish wound healing. Long-term effects from hyperglycemia include nerve damage, renal disease, and cardiovascular disease. Consistently high fasting blood sugar readings may be a sign that you need to alter their diabetes medication or make dietary and lifestyle adjustments. 
&nbsp;

Low blood sugar levels in diabetics can result in symptoms including perspiration, shakiness, dizziness, disorientation, and irritability. Hypoglycemia can cause seizures, comas, and even death in extreme circumstances. You may need to adjust your diabetes medication, your food intake, or your level of physical activity if your fasting blood sugar levels are consistently low because it&rsquo;s a sign of not eating enough or exercising too much. 
&nbsp;

Tips for Mangament

A healthy blood sugar level is necessary for your overall well-being. 
&nbsp;

<ol>
	<li>Maintain a nutritious diet: A diet low in processed foods, sugar, and saturated fats, and high in complex carbs, fiber, and protein will help control blood sugar levels.</li>
	<li>Engage in regular exercise: Exercise helps enhance insulin sensitivity, which can help control blood sugar levels. Aim for 150 minutes or more per week of light-moderate intensity exercise.</li>
	<li>Test blood sugar levels often: Checking your blood sugar level regularly helps you keep a track of it and alter your diet and medication accordingly.</li>
	<li>Maintain a healthy weight: Obesity and being overweight are linked to an increased risk of diabetes and other illnesses. Diet and exercise-based weight management can help control blood sugar levels.</li>
	<li>Get adequate sleep: Sleep deprivation can throw off the body&rsquo;s hormonal balance, which can impair how well blood sugar is regulated. Don&rsquo;t be a night owl; sleep for 7-8 hours every night. 
	&nbsp;</li>
</ol>

So, there you have it, folks &ndash; checking your blood sugar levels while fasting is no laughing matter. Remember to stick to a healthy diet, exercise regularly, and get enough rest to keep your blood sugar levels in check. And when in doubt, don&#39;t hesitate to reach out to your healthcare provider for guidance. 
&nbsp;

<ul>
	<li>Blood sugar levels are crucial for your general health and well-being.</li>
	<li>Fasting blood sugar tests, which can provide important details about how effectively your body is metabolizing glucose, is one way to monitor your blood sugar levels. 
	&nbsp;</li>
</ul>

[1] American Diabetes Association. (2021). Standards of medical care in diabetes - 2021. Diabetes Care, 44(Supplement 1), S1-S232. doi: 10.2337/dc21-S000.

[2] American Heart Association. (n.d.). Managing blood sugar with physical activity.

[3] Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020.

[4] Mayo Clinic. (2021). Hypoglycemia.

[5] Mayo Clinic. (2021). Blood sugar testing: Why, when and how.

[6] National Institute of Diabetes and Digestive and Kidney Diseases.

[7] National Institute of Diabetes and Digestive and Kidney Diseases. (2021).

[8] Powers, M. A., Bardsley, J. K., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., . . . Vivian, E. M. (2017). Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educator, 43(1), 40-53. doi: 10.1177/0145721716689694

[9] World Health Organization. (2021). Obesity and overweight.

[10] International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: IDF, 2021.

[11] World Health Organization. The top 10 causes of death. Updated January 2021.

[12] Pakistan Diabetes Association. About diabetes.

[13] Sabir A, Ohri-Vachaspati P, Singh A, Kern DM, Zhao Y, Crespo NC, et al. Prevalence and correlates of diagnosed and undiagnosed diabetes mellitus and prediabetes in Pakistan: Results from a nationally representative survey. PLoS One. 2020;15(6):e0234451

Arbaz Ansari

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

O’ Sweet Kidney Of Mine!

This is surely not an article on how cannibalism is good. I mean there shouldn’t be any articles on “how cannibalism is good”, right? Rest assured, the information summoned here, is related to the sugary stuff and its effects on your health. So, get ready as you’re in for a treat, no pun intended!

Understanding Diabetic Nephropathy

Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, then, refers to the deterioration of the kidney as a result of longstanding or complicated diabetes<a href="#accordion">[5]</a>. As the disease progresses and reaches the final stage, it is termed as kidney failure or end-stage renal disease (ESRD)<a href="#accordion">[2]</a>.&nbsp;

According to the CDC reports, diabetes is the most common cause of ESRD. In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had kidney transplant<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

There are essentially two types of diabetes:&nbsp;

1. Type I (Inherited or Juvenile)&nbsp;

2. Type II (Adapted)

&nbsp;

Type I diabetes is the most likely of the two types of diabetes to progress into ESRD, the fifth and last stage of diabetic nephropathy, while patients who develop type II diabetes mellitus may present with albuminuria (the presence of albumin protein in the urine) at the time of diagnosis.

However, diabetic nephropathy in type I diabetes develops over the course of 15-20 years after the diagnosis. This difference in the timeline is because it&rsquo;s difficult to pinpoint the precise onset of type II diabetes. It&rsquo;s identified only when the kidney&rsquo;s structural and functional changes occur due to diabetes, causing proteinuria and hypertension the hallmarks of diabetic nephropathy<a href="#accordion">[1]</a>. 
&nbsp;

<ul>
	<li>Ethnic Groups: Some groups of the population, such as&nbsp;African Americans, Native Americans, and Mexican Americans, are more at risk than others. Researchers have noted familial clustering (occurrence of the disease within some families in excess of what would be expected from the occurrence in the population) in these cases, which indicates that genetics also play a vital role in developing nephropathy<a href="#accordion">[1]</a>.&nbsp;</li>
	<li>Blood Sugar Level: The high levels of blood sugar associated with diabetes damage the kidney through various pathways. The damage is mostly directed toward&nbsp;the blood vessels that are responsible to filter the blood in order to make urine.</li>
</ul>

&nbsp;

Diabetic nephropathy has a high morbidity and mortality rate&nbsp;mainly because of other issues due to diabetes<a href="#accordion">[1]</a>:

<ul>
	<li>Chronic Kidney Disease (CKD): As of now, diabetic nephropathy is the leading cause of CKD in the United States as well as other Western societies<a href="#accordion">[6]</a>.&nbsp;</li>
	<li>Hypertension: Like CKD, hypertension (commonly known as high blood pressure) is also believed to be both a cause of and a result of the damage that is done by the disease. An individual suffering from uncontrolled hypertension progresses toward&nbsp;stage V diabetic nephropathy faster than those who don&rsquo;t have high blood pressure<a href="#accordion">[2]</a>.&nbsp; 
	&nbsp;</li>
</ul>

On the basis of the clinical presentation, doctors have broken down this kidney disease into 5 stages, depending on the glomerular filtration rate (GFR) which is essentially the rate at which the kidneys filter the blood. GFR is basically a representation of the effectiveness of the kidney function in percentage. The stages are as follows<a href="#accordion">[3]</a>:

Stage 1: The kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.

Stage 2: The kidney faces some degree of damage and a GFR of 60&ndash;89% is observed.

Stage 3: Mild to severe loss of kidney function is recorded with a GFR of 30&ndash;59%.

Stage 4: This stage refers to the severe loss of function and a GFR of 15&ndash;29%.

Stage 5: Kidney failure and a GFR of under 15% defines stage 5. 
&nbsp;

Diabetic nephropathy is always a cause for alarm if the individual has diabetes mellitus as a comorbidity along with a history of the following<a href="#accordion">[1]</a>:

1. Foamy urine

2. An unexplained proteinuria

3. Diabetic retinopathy, i.e., diabetes affecting the visual sense

4. Fatigue and foot edema because of hypoalbuminemia, i.e., decreased levels of albumin protein)

5. Hypertension

6. Coronary artery disease

&nbsp;

Diabetic nephropathy sounds dangerous, and rightfully so! However, there are ways to lower the risk<a href="#accordion">[4]</a>:&nbsp;

<ul>
	<li>Keep up with regular checkups; an annual appointment with a healthcare team helps with diabetes management, hence, helping avoid complications like diabetic nephropathy, retinopathy, and neuropathy.&nbsp;</li>
	<li>Take antidiabetic drugs with utmost efficiency. When it&rsquo;s impossible to resist chocolate cake, tiramisus, or maybe some soft succulent, and sweet gulab jamuns, why hold back on the medicines that actually allow devouring these delicacies in moderation? There is no doubt that medication can be very effective and may even help prevent diabetic nephropathy.&nbsp;</li>
	<li>Manage blood pressure as it increases the risk of kidney disease<a href="#accordion">[3]</a>. Moreover, take care while taking nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as they can lead to kidney damage in case of diabetic nephropathy.&nbsp;</li>
	<li>Also try to maintain a balanced body mass index<a href="#accordion">[3]</a>.&nbsp;</li>
	<li>Another crucial thing to take care of&nbsp;to avoid diabetic nephropathy and its complications is smoking. The solution is pretty simple: don&rsquo;t smoke. Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse<a href="#accordion">[3]</a>.</li>
</ul>

&nbsp;

A doctor advising medical intervention will discuss the best drug according to the severity of the disease. Therapeutic agents for glycemic (sugar) control in diabetic patients, who have developed kidney disease as well, include<a href="#accordion">[3]</a>:

<ul>
	<li>Dipeptidyl Peptidase Inhibitors, e.g., Sitagliptin</li>
	<li>Alpha-Glucosidase Inhibitors, e.g., Acarbose</li>
	<li>Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors, e.g., Canagliflozin</li>
	<li>Glucagon-like peptide-1 (GLP-1) Receptor Agonists or Incretin Mimetics, e.g., Dulaglutide&nbsp;</li>
	<li>Amylin Analogs, e.g., Pramlintide</li>
	<li>Nonsteroidal, Selective Mineralocorticoid Receptor (MR) Antagonists, e.g., Finerenone&nbsp; 
	&nbsp;</li>
</ul>

It may take months or years for complications of diabetic nephropathy to develop. Whatever the reason, whether it was non-compliance on your part or whether it was due to the fact that the disease was already in its advanced stages, it is important to know the current status of your condition so that it can be treated accordingly before it develops into the following complications<a href="#accordion">[4]</a>:

1. Fluid Retention: Fluid retention can cause swelling in the arms and legs, hypertension, or even cause pulmonary edema, whereby fluid builds up in the lungs.

2. Hyperkalemia: Hyperkalemia is an increase in potassium levels in the blood and it can lead to abnormal heart rhythms.

3. Cardiovascular Disease: Another major complication is cardiovascular diseases which, in turn, can lead to stroke.

4. Diabetic Retinopathy: Uncontrolled diabetic nephropathy can also damage the blood vessels of the retina, the light-sensitive tissue at the back of the eye, and cause diabetic retinopathy.

5. Blood Loss: It will lead to a reduced number of red blood cells to transport oxygen, a condition known as anemia

6. Bone And Mineral Disorders: Since the kidneys are losing their ability to function properly, it will affect the level of calcium and phosphorus in blood.

7. Miscellaneous Conditions: Some other conditions caused due to diabetic nephropathy are foot sores, erectile dysfunction, diarrhea, damaged nerves and blood vessels, and pregnancy complications. 
&nbsp;

Dialysis or a kidney transplant is used as the last resort, i.e., if the kidneys are damaged beyond repair, then the patient may need dialysis on a regular basis - at least until they can get a transplant - to survive<a href="#accordion">[3]</a>.

&nbsp;

Additionally, the doctor may give some instructions regarding their diet to avoid an unfortunate event<a href="#accordion">[3]</a>:

<ul>
	<li>Water: Water is definitely essential; however, excess fluid can increase the risk of swelling and hypertension.</li>
	<li>Sodium: An excessive intake of sodium can raise blood pressure pathologically.</li>
	<li>Protein: A drawback of kidney disease is the consumption of too much protein can lead to a buildup of waste products in the blood, putting unnecessary pressure on the kidneys</li>
	<li>Phosphorus: Phosphorus is found in high quantities in dairy products. A high level of phosphorus can weaken the bones and again put excessive pressure on the kidneys.</li>
	<li>Potassium: People with kidney disease reportedly have a higher level of potassium than a healthy adult; too much and/or too little&nbsp;potassium is bad for the neurons. 
	&nbsp;</li>
</ul>

Diabetes takes away a person’s integrity slowly and bit by bit. However, with due management and precautionary methods, it can be kept at bay and the patient can live a fairly decent life filled with heavenly desserts (in moderation of course)!

<ul>
	<li>Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, by extension, is the deterioration of the kidney due to long-standing or complicated diabetes.</li>
	<li>According to the CDC reports, diabetes is the most common cause of ESRD.</li>
	<li>In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had undergone a kidney transplant.</li>
	<li>There are essentially 5 stages of diabetic nephropathy; ESRD is the fifth and last stage.</li>
	<li>Some groups, such as African Americans, Native Americans, and Mexican Americans are at a high risk of developing diabetic nephropathy.</li>
	<li>Researchers have noted familial clustering, which means that genetics play a vital role in developing nephropathy.</li>
	<li>Diabetic nephropathy is one of the most prominent long-term complications when it comes to morbidity and mortality of a diabetic person.</li>
	<li>Hypertension is an inevitable threat posed by diabetes. It is also a major reason why diabetic nephropathy develops in the first instance.</li>
	<li>The damage is mostly directed towards the blood vessels responsible to filter the blood to make urine.</li>
	<li>If the kidney&rsquo;s structural and functional changes occur due to diabetes, it results in proteinuria and hypertension, which are the hallmarks of diabetic nephropathy.</li>
	<li>Diabetic nephropathy is an alarming condition given the patient also has diabetes mellitus as a comorbidity.</li>
	<li>Do not skip regular checkups. An annual appointment with the healthcare team is necessary since it sheds light on how well the person can manage diabetes, and thereby, avoid complications like diabetic nephropathy, retinopathy, and neuropathy.</li>
	<li>Moreover, take nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as prescribed by the doctor since their side effects often include kidney damage.</li>
	<li>Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse.</li>
	<li>Kidney disease is categorized into 5 stages, depending on the glomerular filtration rate.</li>
	<li>In Stage 1, the kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.</li>
	<li>In Stage 2, the kidney faces some degree of damage&nbsp;and a GFR of 60&ndash;89% is observed.</li>
	<li>Stage 3 is when there is mild to severe loss of kidney function and a GFR of 30&ndash;59%.</li>
	<li>Stage 4 refers to the severe loss of function and a GFR of 15&ndash;29%.</li>
	<li>Stage 5 is defined by kidney failure and a GFR of under 15%.</li>
	<li>The doctor may suggest a medical intervention to discuss the treatment options according to the severity of the disease.</li>
	<li>Complications of diabetic nephropathy include fluid retention, diabetic retinopathy, and hyperkalemia.</li>
	<li>If a person has diabetic nephropathy, then they need to keep a check on their intake of sodium, phosphorus, and water specifically.</li>
</ul>

[1] Diabetic nephropathy - statpearls - NCBI bookshelf.

[2] Diabetic nephropathy (kidney disease). Diabetic Nephropathy (Kidney Disease) | Johns Hopkins Medicine.

[3] Diabetic nephropathy: Symptoms, stages, causes, and treatment. Medical News Today.

[4] Diabetic nephropathy (kidney disease). Mayo Clinic.

[5] EmmaHook. Diabetic nephropathy (kidney disease). Diabetes UK.

[6] Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: Diagnosis, prevention, and treatment. American Diabetes Association.

Medilink Consultant clinic

Saad Ullah Siddiqui

Best Exercises For Diabetics In Ramadan!

Fasting during Ramadan is one of the five pillars of Islam. The holy month is a time of spiritual reflection that is meant to develop a sense of gratitude and discipline, encouraging self-improvement and knitting the community closer.

For all its benefits, though, we know Ramadan can be challenging for diabetic people. However, one trick to managing these blood sugar spikes is regular exercise.

Oh no, don&rsquo;t worry! These are not high-intensity activities. The following exercises can easily be integrated into a daily routine without causing excessive strain or fatigue<a href="#accordion">[1][2]</a>: 
&nbsp;

Understanding Best Exercises For Diabetics In Ramadan

<ul>
	<li>
	<h5>Walking</h5>
	</li>
</ul>

Walking is an excellent low-impact exercise for <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetics </a>as it not only improves blood sugar control but also reduces the risk of heart disease. You can go out for a walk before Suhoor or after Iftar when your body has sufficient energy to fuel the activity.

&nbsp;

<ul>
	<li>
	<h5><a href="https://merisehat.pk/article/yoga-a-life-changing-approach">Yoga</a></h5>
	</li>
</ul>

Yoga is a gentle, cost-effective form of exercise that&rsquo;s more famous for improving body flexibility. But do you know it helps your body manage stress levels, too? It really does! So, if you&rsquo;re struggling to cope mentally and/or physically, then this is for you! Yoga during Ramadan will improve your blood circulation, lower blood pressure, manage insulin levels, and even help you maintain a healthy weight.

&nbsp;

<ul>
	<li>
	<h5>Tai Chi</h5>
	</li>
</ul>

Tai chi is an ancient Chinese practice involving slow movements and deep breathing. It is an effective way for people with type 2 diabetes to manage their blood glucose and A1C levels. Additionally, this form of meditation is known to improve balance and reduce nerve damage, although more research is required in this regard.

&nbsp;

<ul>
	<li>
	<h5>Swimming</h5>
	</li>
</ul>

Swimming during Ramadan helps cool down the body temperature and, consequently, reduces the loss of fluid through sweating. Also, it&rsquo;s a full-body workout, so it will leave you feeling more energetic and focused to go about your daily tasks. Moreover, it doesn&rsquo;t matter if you are at risk of gestational diabetes, young or elderly, or have hypertension or heart conditions; the exercise is ideal for everyone who&rsquo;s tackling diabetes in Ramadan without exhausting their bodies.

NOTE: Make sure to inform the lifeguard about your medical condition before taking a dip.

&nbsp;

<ul>
	<li>
	<h5>Cycling</h5>
	</li>
</ul>

Cycling is yet another exercise that doesn&rsquo;t put excessive pressure on your joints. It can be done indoors or outdoors, whichever is more convenient or suits your condition best. According to recent research, nearly half of the people with type 2 diabetes also have arthritis. Factors like diabetic neuropathy and obesity only make you more susceptible to suffering from joint pain. Cycling helps you keep up with your fitness goals while fasting. 
&nbsp;

<ol>
	<li>Begin slowly, especially if you haven&#39;t been physically active in a while. Do a 5-minute warm-up before exercising. Similarly, finish off with a 5-minute cool-down after exercising.</li>
	<li>Check blood sugar levels before and after exercise to understand how your body responds to it.</li>
	<li>Make sure your blood sugar is less than 250 mg/dl before exercising.</li>
	<li>Wear a medical alert ID band and carry a cell phone in case of emergency.</li>
	<li>Avoid exercising in extremely hot or cold temperatures.</li>
	<li>Always listen to your body. If you feel dizzy or short of breath, stop immediately.</li>
</ol>

NOTE: Always consult with a doctor before starting an exercise program to ensure it&#39;s safe and suitable for your condition<a href="#accordion">[3]</a>. 
&nbsp;

Fasting during Ramadan can make it challenging for diabetic people to maintain a regular exercise routine. Remember, it&rsquo;s okay to modify physical activities to suit your body&rsquo;s needs during this time. Some strategies include adjusting the timing and intensity of exercise, staying hydrated, and monitoring blood glucose levels closely. Consulting with a healthcare professional before starting any exercise program during Ramadan is essential. 
&nbsp;

[1] Grey H. The best 10 exercises if you have diabetes. Healthline.

[2] Migala J, By. 6 great exercises for people with diabetes. EverydayHealth.com.

[3] Team CC. 5 best exercises for people with diabetes. Cleveland Clinic.

Sarah Mhowwala

Importance Of Hydration During Ramadan For Diabetics!

Muslims around the globe observe Ramadan, an important time when they fast for 29-30 days from dawn until dusk. If fasting is not done safely and properly, Ramadan may cause fasting-related complications, such as hypoglycemia, dehydration, and hyperglycemia. Maintaining hydration is essential for the general health and well-being of diabetics, particularly during Ramadan. The body loses fluids during the fasting period, which causes dehydration. Dehydration can cause headaches, lightheadedness, and lethargy, as well as elevated blood sugar levels in <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetic</a>s.&nbsp; 
&nbsp;

Understanding Importance Of Hydration During Ramadan For Diabetics

To stay hydrated during Ramadan, diabetics need to drink plenty of water and other fluids between Iftar (the evening meal) and Suhoor (the pre-morning meal). It&#39;s important to drink fluids in small amounts regularly throughout the night rather than in large amounts at once. Additionally, consuming foods specifically fruits and vegetables with high water content, such as watermelon, cucumbers, and oranges, can help maintain hydration levels.

Here are some tips on how diabetics can stay hydrated:

<ol>
	<li>&nbsp;Drink Plenty Of Water And Other Fluids: Drink at least eight glasses of water during non-fasting hours between Iftar and Suhoor. Try to consume fluids in small amounts regularly throughout the night rather than large amounts at once.&nbsp;</li>
	<li>&nbsp;Consume Foods With High Water Content: Eating foods with high water content can help maintain hydration levels. Some examples include watermelon, cucumbers, oranges, strawberries, and lettuce.</li>
	<li>&nbsp;Avoid Caffeine And Sugar: Caffeinated and sugary drinks can lead to dehydration, so it&#39;s best to avoid them during Ramadan.</li>
	<li>&nbsp;Use A&nbsp;Humidifier: A humidifier can help maintain moisture levels in the air and prevent dehydration during fasting.</li>
	<li>&nbsp;Monitor Blood Sugar Levels: High blood sugar levels can cause dehydration, so it&#39;s essential to monitor blood sugar levels regularly and adjust medication accordingly.</li>
	<li>&nbsp;Consult With A&nbsp;Healthcare Professional: People with diabetes should consult with their healthcare professional before fasting in Ramadan to ensure it&#39;s safe for them to do so and get personalized advice on how to manage their diabetes and hydration during fasting.</li>
	<li>&nbsp;Avoid Strenuous Exercise: Diabetics are advised to avoid any strenuous exercise, especially before iftar or late in the evening.</li>
</ol>

By following these tips, diabetics will be able to maintain hydration levels during fasting in Ramadan and prevent complications linked with dehydration. 
&nbsp;

While dehydration is a cause for concern, overhydration can also be a possible complication in diabetics. In rare cases, excessive consumption of water can lead to overhydration. This can result in hyponatremia (low blood sodium levels), which can be troublesome for diabetics. As a result, it&#39;s crucial to regulate fluid intake and refrain from overindulging.

Dehydration from inadequate water intake can result in elevated blood sugar levels. On the other hand, hyponatremia from overhydration can result in convulsions or even a coma<a href="#accordion">[1]</a>. 
&nbsp;

In conclusion, diabetics are advised to take precautions to avoid dehydration during Ramadan. It&#39;s important to drink fluids regularly in small amounts, consume foods with high water content, and avoid overhydration. By following these simple hydration tips, people with diabetes can have a safe and healthy Ramadan while effectively managing their diabetes. 
&nbsp;

[1] Tootee A, Larijan B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. Journal of Diabetes & Metabolic Disorders. 2021 Jun;20:1085-91.

Syeda Qurat-ul-Ain

Iqra Mazhar

Recommended Exercises For Diabetics Of Different Age Groups In Ramadan

Ramadan is a special month in the Islamic calendar where Muslims fast from dawn to dusk. It is a time of spiritual reflection, self-discipline, and increased charity. However, fasting during Ramadan can be challenging for diabetics. It is crucial to consult a doctor or a dietitian before starting the fast, especially for those with diabetes. The management of diabetes during Ramadan requires careful planning, especially when it comes to exercise.

<a href="https://merisehat.pk/article/best-exercises-for-diabetics-in-ramadan">Exercise </a>can help manage blood sugar levels, improve insulin sensitivity, and sustain overall health. However, the type and intensity of exercise may vary based on age, physical fitness level, and diabetes medication.

&nbsp;

Understanding Recommended Exercises For Diabetics Of Different Age Groups In Ramadan

Here are some recommended exercises for diabetics of different age groups during Ramadan:

&nbsp;

<ul>
	<li>
	<h5>Children And Teenagers</h5>
	</li>
</ul>

Encouraging children to engage in physical activities can help mitigate their risk of developing type 2 diabetes in the future. Diabetic children and teenagers can perform low- to moderate-intensity exercises, such as swimming, cycling, dancing, or playing a sport. However, parents and children should stay alert for any signs of hypoglycemia and dehydration.

&nbsp;

<ul>
	<li>
	<h5>Adults</h5>
	</li>
</ul>

During Ramadan, it is best to schedule exercise sessions in the early morning or after the iftar. It is also essential to monitor blood sugar levels before, during, and after exercise, especially for those who take insulin or other diabetes medications that can cause hypoglycemia.

Aerobic exercises and strength training are considered safe and beneficial for diabetics during Ramadan. Moderate- to low-intensity exercise regimes which include brisk walking, yoga, swimming, tai chi, and cycling can all be performed during fasting. Furthermore, Taraweeh prayer which consists of constant bowing, kneeling, and rising can also be considered a part of daily exercise activities.

&nbsp;

<ul>
	<li>
	<h5>Elderly</h5>
	</li>
</ul>

Older people with diabetes may have difficulty engaging in high-intensity physical activities. Therefore, they should focus on light to moderate-intensity exercises such as walking, stretching, or yoga. These activities can help improve flexibility and balance, and reduce the risk of falls<a href="#accordion">[1]</a>.

It is crucial to avoid high-intensity activities that may cause fatigue or exhaustion, leading to low blood sugar levels during the fast. Additionally, older adults should consult their healthcare provider before starting any new exercise program. 
&nbsp;

In conclusion, exercise is an essential component of managing diabetes during Ramadan. The type and intensity of exercise may vary based on age, physical fitness level, and diabetes medication. Intense exercise, and exercising late in the evening or before iftar is generally not recommended for diabetics during Ramadan. This is due to the risk of hypoglycemia and dehydration.

It is crucial to consult a healthcare provider before starting any new exercise program, especially during Ramadan. Remember to monitor blood sugar levels before, during, and after exercise, and to stay hydrated by drinking plenty of water and other non-caffeinated, sugar-free beverages. 
&nbsp;

[1] The National Council on Aging.

[2] Pregnancy and diabetes. Exercise with diabetes during pregnancy - Eastern Virginia Medical School (EVMS), Norfolk, Hampton Roads.

[3] RECOMMENDED PHYSICAL ACTIVITY PARTICIPATION FOR PEOPLE WITH DIABETES.

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Sugar Levels, Insulin, And Ramadan

Ramadan is a religious month observed by millions of Muslims worldwide. For many Muslims, this period alters their dietary habits, which can impact sugar levels and <a href="https://merisehat.pk/article/insulin-dose-and-timings">insulin </a>sensitivity. 
&nbsp;

Sugar-Levels

<h5 style="text-align:justify">Normal Sugar Levels and Fasting Blood Sugar Levels</h5>

The normal sugar level for an adult is between 70-99 mg/dL when fasting. If the blood sugar level is&nbsp; between 100 to 125 mg/dL, it is indicative of prediabetes, and above 126 mg/dL after an overnight fast, is a sign of diabetes.

&nbsp;

<h5 style="text-align:justify">Fasting Sugar Level in <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a></h5>

Diabetes is a metabolic disorder characterized by high blood sugar levels resulting from a deficiency of insulin or a lack of sensitivity to insulin. According to the International Diabetes Federation (IDF), an estimated 537 million adults are living with diabetes1. This number is expected to rise to 783 million by 2045.1

For diabetics, managing their blood sugar levels is crucial in order to prevent complications, especially during Ramadan

&nbsp;

<h5 style="text-align:justify">Blood Sugar Level During Ramadan</h5>

During Ramadan, people who are fasting refrain from food and drink for an extended period of time, which can affect their blood sugar levels. During fasting, the liver releases glucose to provide energy to the body, and insulin helps the cells to take up the glucose from the bloodstream. However, the lack of nutrition can cause blood sugar levels to drop too low, leading to hypoglycemia, especially for diabetics who are on insulin or other blood sugar-lowering medications.

&nbsp;

<h5 style="text-align:justify">Does Fasting Affect Blood Sugar?</h5>

Fasting can have both positive and negative effects on blood sugar levels. For diabetics, fasting can lead to hypoglycemia if their medication dose is not adjusted accordingly. Thus, leading to dizziness, confusion, and in severe cases, loss of consciousness. On the other hand, some studies have shown that fasting (if done safely) can improve insulin sensitivity, lower blood sugar levels, and reduce the risk of developing diabetes.

&nbsp;

<h5 style="text-align:justify">Insulin</h5>

Insulin is a hormone released by the pancreas and helps regulate blood sugar levels. When one consumes food, the pancreas releases insulin into the bloodstream, which helps the cells to take up glucose from the blood and use it for energy, or store it as glycogen or fat. In diabetics, the pancreas either doesn&#39;t produce enough insulin or the body doesn&#39;t respond to insulin properly, leading to high blood sugar levels.

&nbsp;

<h5 style="text-align:justify">Fasting Glucose Levels</h5>

During fasting, the body relies on stored energy to function, including glycogen in the liver and muscle tissue, and fat in adipose tissue. The liver releases glucose into the bloodstream to maintain blood sugar levels, especially during prolonged fasting. However, in diabetics, the liver may release too much glucose, leading to hyperglycemia. 
&nbsp;

In conclusion, fasting in Ramadan can affect sugar levels and insulin sensitivity, especially for people with diabetes. It is important for diabetics to consult their healthcare provider to adjust their medication doses and monitor their blood sugar levels during Ramadan. Moreover, people who are fasting during Ramadan should also be aware of the potential risks of hypoglycemia and take steps to prevent it, such as breaking the fast with a snack that is less in carbs and high in proteins. 
&nbsp;

[1] Diabetes Facts & Figures. International Diabetes Federation - Home.

Best Regimens For Diabetics During Ramadan

<a href="https://merisehat.pk/disease/diabetes-type-1-and-2">Diabetes</a> management during Ramadan is essential to avoid any health complications. This includes taking your medications as prescribed by your doctor and monitoring your blood sugar levels regularly. But more importantly, it involves being aware of the signs of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) and taking appropriate action when necessary. 
&nbsp;

Fasting Tips  for Diabetics

<ol>
	<li>Consult With A Healthcare Professional: Consult your doctor to determine if fasting is safe for you. Yes, fasting during Ramadan is a religious obligation, but it doesn&rsquo;t mean neglecting your health. 
	&nbsp;</li>
	<li>Monitor Blood Sugar Levels: Monitor your blood sugar levels regularly, especially during the fast. Inform your doctor if you notice any spike in these readings. 
	&nbsp;</li>
	<li>Stay Hydrated: Dehydration can cause blood sugar levels to rise, so make sure to drink plenty of water after Iftar/before Suhoor. 
	&nbsp;</li>
	<li>Consume Low Glycemic Index Foods: The glycemic index is a scale that measures how quickly foods raise blood sugar levels. </li>
</ol>

 
Foods with a high GI are digested quickly and cause a sudden spike in blood sugar levels, whereas foods with a low GI are digested more slowly and do not cause a sudden spike in blood sugar levels. 
&nbsp;

So, do yourself a favor and fill your plate with: 
&nbsp;

<ul>
	<li>Non-starchy vegetables, such as spinach, broccoli, and carrots</li>
	<li>Whole grains, such as brown rice, quinoa, and whole-wheat bread</li>
	<li>Lean protein, such as fish, chicken, and tofu</li>
	<li>Healthy fats, such as nuts, seeds, and avocado 
	&nbsp;</li>
</ul>

And at the same time, as tempting as they appear to be during Ramadan, keep away from high glycemic foods, such as: 
&nbsp;

<ul>
	<li>Sugary drinks, such as soda, juice, and sports drinks</li>
	<li>Processed snacks, such as chips and crackers</li>
	<li>White bread and pasta</li>
	<li>Fried foods, such as fried chicken and fries</li>
	<li>High-fat meats, such as bacon and sausage 
	&nbsp;</li>
</ul>

<ol start="5">
	<li>Do Not Skip Meals: Your body is already low on essential nutrients due to fasting. Skipping your dinner after Iftar or your Sehri can lead to hypoglycemia during the day.</li>
</ol>

&nbsp;

<ol start="6">
	<li>Break The Fast With A Balanced Meal: Have a balanced meal at Iftar that includes low glycemic index foods, protein, and healthy fats. 
	&nbsp;</li>
</ol>

Nutrient Content Guidance

<h5>Nutritional Recommendations:</h5>

<ul>
	<li>Carbohydrates: Consume 40-50% of daily calories from low-glycemic, high-fiber, whole grain sources</li>
	<li>Protein: Consume 20-30% of daily calories from lean meat, legumes, pulses, and vegetable protein sources.</li>
	<li>Fat: Consume less than 35%, with saturated fat intake under 7%. Choose healthier cooking methods, such as grilling, baking, and steaming.</li>
</ul>

&nbsp;

<h5>Lifestyle Recommendations:</h5>

<ul>
	<li>Hydration: Drinking enough water at Iftar helps overcome dehydration from fasting.</li>
	<li>Physical Activity: Staying active promotes overall health.</li>
	<li>Sleep: Maintaining a regular sleep schedule helps avoid sleeping longer than usual. 
	&nbsp;</li>
</ul>

Balanced and Healthy Meal Plan

Normally, a person should consume 1500 calories per day. This is how you can manage your meal plans: 
&nbsp;

Suhoor: 450-600 kcal/Meal

&bull; Omelette, 2 egg

&bull; Roti, 1 small

&bull; Milk/Lassi, 1 glass

&bull; Salad (tomatoes/onions), 1 small bowl

&bull; Water, 2 glasses 
&nbsp;

Iftar Snack: 150-240 kcal/Meal

&bull; Fruit, 1

&bull; Water/unsweetened drinks, 2 glasses

&nbsp;

Iftar Meal: 500-750 kcal/Meal

&bull; Chicken roast, 1 palm size

&bull; Daal/lentil curry, 1 cup

&bull; Vegetable curry, 1 cup

&bull; Cooked brown rice, &frac34; cup

&bull; Dahi baray, 1 small bowl

&bull; Salad

&bull; Water/unsweetened drinks, 2 glasses

&nbsp;

Post-Iftar Healthy Snack: 150-300 kcal/Meal

&nbsp;&bull; Fruit, 1 piece

&bull; Milk-based dessert (e.g., kheer, ras malai made with sweetener), 1 small

&bull; Water/unsweetened drinks, 2 glasses 
&nbsp;

Note: This is what a diabetic person can eat on average during Ramadan. Your diet can vary based on your daily calorie goals. 
&nbsp;

As a diabetic person, you need to take extra care of your health during Ramadan. Make sure to take meds as prescribed by your doctor and monitor your blood sugar levels regularly to stay fit while fasting during Ramadan. What&rsquo;s more, you can ask your doctor to refer a registered dietitian who can develop a personalized nutrition plan that meets your individual needs. 
&nbsp;

[1] CARB counting and diabetes. Carb Counting and Diabetes | ADA.

[2] IDF clinical practice recommendations for managing type 2 diabetes in

[3] Author links open overlay panelMohamed Hassanein a, a, b, et al. Diabetes and ramadan: Practical guidelines. Diabetes Research and Clinical Practice.

Nutrition Guidelines For Sehr And Iftaar Meals

Ramadan is the most revered month in the Islamic calendar when Muslims all around the world maintain a fast from sunrise to sunset. This month is not only about abstaining from food and drink but also engaging in more prayer, spiritual meditation, and charitable deeds. The two major meals of the day during Ramadan are Sehr and Iftaar, and they are extremely important in this fasting journey.

&nbsp;

Several researchers have studied the effects of Ramadan on energy balance and weight regulation. While results have shown a decrease in body weight, body fat percentage, <a href="https://merisehat.pk/article/checking-sugar-while-fasting">fasting blood sugar</a>, and circulating triglycerides, these changes were seen to be short-lived1. Elevated insulin resistance at the end of Ramadan has also been observed1. Furthermore, fasting has not been shown to significantly affect mood, fatigue, and a person&rsquo;s quality of life<a href="#accordion">[2]</a>.&nbsp;Thus, studies have shown that fasting can lead to both positive and negative health outcomes<a href="#accordion">[1]</a>. 
&nbsp;

It is important to understand that fasting can be a great way to improve your health, as long as it&#39;s done safely and in a state of good health. If you&#39;re planning on fasting, it&#39;s important to eat healthy and nutritious meals during sehr and iftaar to get the maximum benefits. 
&nbsp;

Don&#39;t know what to eat? No problem! Read on for some healthy and tasty meal ideas. 
&nbsp;

Sehr - The Pre-Dawn Meal

Muslims eat Sehr or Sahur in the early hours of the morning before sunrise. The goal of Sehr is to supply the body with enough energy so that it can last from sunrise to sunset. At Sehr, it is advised to eat a balanced meal with complex carbohydrates, lean protein, as well as healthy fats.

&nbsp;

<h5>Ideal Foods for Sehr</h5>

Suitable foods for Sehr include whole grains, oats, and lentils because they are high in fiber and digest slowly. These nutrients aid in maintaining feeling satisfied and energized all day long by gradually releasing energy. To ensure that one remains hydrated all day, it is also advised to drink lots of water throughout the period from Iftaar to the next Sehr.

&nbsp;

<h5>Examples of Sehr Foods</h5>

A few examples of healthy Sehr meals include:

<ul>
	<li>Oatmeal mixed with nuts and fruit</li>
	<li>Eggs on whole-wheat toast</li>
	<li>Lentil soup with brown rice</li>
	<li>Yogurt with honey and berries</li>
</ul>

&nbsp;

These foods give the body the vital nutrition and energy it needs for a pleasant and satisfying fast.

&nbsp;

Iftaar - The Post-Sunset Meal

Muslims end their fast at sundown by eating Iftaar. Iftaar is meant to refuel the body with vital nutrients as well as provide one with energy for the rest of the day. Usually, Iftaar is a time when the community and family gather to eat together.

&nbsp;

<h5>Breaking The Fast With Dates And Water</h5>

As per religious traditions, it is recommended to end the fast with dates and water. A quick snack, like soup or a salad, should then be consumed to assist the digestive system to adjust to eating again.

&nbsp;

<h5>Ideal Foods For Iftaar</h5>

During Iftaar, it&#39;s crucial to eat nutrient-dense foods like fruits, vegetables, and lean protein. Avoid eating foods that are high in sugar and fats. Moreover, fried foods should be avoided because they might aggravate digestion and result in weight gain.

&nbsp;

<h5>Examples Of Iftaar Foods</h5>

Samosas, pakoras, dates, chana chaat, fruit chaat, and haleem are other popular Iftaar foods. Not only are these foods delightful, but they also give the body important nutrients. However, the consumption of fried foods during Iftaar can be detrimental to a person&rsquo;s health. Therefore, they should be eaten in moderation.

&nbsp;

The body needs essential nutrients during the fast to sustain energy levels and to ensure overall well-being. People often tend to eat less during sehr, hence making Iftaar an important contributor of calories [&lrm;65%]&lrm;, lipids [&lrm;74%]&lrm;, proteins [&lrm;71%]&lrm; , and carbohydrates [&lrm;56%]&lrm;<a href="#accordion">[3]</a>. 
&nbsp;

<ol>
	<li>
	<h5>Maintains Stable Blood Sugar Levels</h5>
	</li>
</ol>

Eating balanced meals during Sehr and Iftaar helps to maintain stable blood sugar levels throughout the day and prevent blood sugar spikes, which can be harmful to renal impaired patients. 
&nbsp;

<ol start="2">
	<li>
	<h5>&nbsp;Reduces The Risk Of Dehydration</h5>
	</li>
</ol>

Consuming fluids during Sehr and Iftaar helps to prevent dehydration, which is important for renal-impaired patients who may be at an increased risk of dehydration. 
&nbsp;

<ol start="3">
	<li>
	<h5>&nbsp;Helps To Manage Electrolyte Balance</h5>
	</li>
</ol>

Consuming foods that are low in potassium and phosphorus helps to manage electrolyte balance, which is important for renal-impaired patients. 
&nbsp;

<ol start="4">
	<li>
	<h5>&nbsp;Provides Essential Nutrients</h5>
	</li>
</ol>

A well-balanced diet provides essential nutrients like vitamins, minerals, and fiber, which are crucial for maintaining good health and managing kidney disease. 
&nbsp;

<ol start="5">
	<li>
	<h5>&nbsp;Controls Weight</h5>
	</li>
</ol>

Eating the right foods can help to control weight and prevent obesity, which is a major risk factor for heart disease. 
&nbsp;

<ol start="6">
	<li>
	<h5>&nbsp;Helps To Manage Cholesterol Levels</h5>
	</li>
</ol>

A diet low in saturated and trans fats can help to manage cholesterol levels, which is important for cardiac patients. 
&nbsp;

<h5>Sehr and Iftaar Food for Renal Impaired Patients</h5>

For people with renal impairment, it&rsquo;s crucial to pay attention to the pre-dawn (Sehr) and evening meals (Iftaar) throughout Ramadan. They should select fresh fruits and vegetables, whole-grain bread, and lean protein sources, and keep away from salty and high-potassium items. A qualified dietician should be consulted to develop a customized meal plan. They can provide personalized recommendations based on the person&rsquo;s specific health needs.

&nbsp;

<h5>Sehr and Iftaar Food for Cardiac Patients</h5>

For cardiac patients observing Ramadan, choosing the right foods during Sehr and Iftaar is crucial for maintaining good health and managing their condition. Lean protein sources like fish and chicken, nutritious grains, fruits, and vegetables should be included, while trans and saturated fats, salt, and added sugars should be kept to a minimum.

A customized meal plan that accounts for each person&#39;s needs and restrictions should be developed in collaboration with a licensed dietitian and cardiologist.

&nbsp;

<h5>Sehr and Iftaar Food for Diabetic Patients</h5>

It&#39;s crucial for diabetics who are fasting throughout Ramadan to make food choices that support stable blood sugar levels. Complex carbohydrates, diets high in protein, and hydration are advised for Sehr. Dates, water, low-GI foods, lean protein sources, veggies, and portion control are all crucial during Iftaar. A trained dietitian&#39;s advice and talking to a healthcare professional are other crucial factors to take into account. To prevent difficulties, it&#39;s critical to constantly check blood sugar levels and break the fast as needed.

&nbsp;

<h5>Sehr and Iftaar Food for Older Persons</h5>

It is crucial for older adults who are fasting during Ramadan to select foods that offer the nutrients they require for optimal health and well-being. For Sehr, complex carbs, diets high in protein and fiber, low-fat foods, and water are advised. Dates and water, as well as a range of low-fat foods, portion management, and hydration, are crucial for Iftaar. Other crucial factors to take into account include eating regularly spaced meals, avoiding overeating, and speaking with a qualified nutritionist or healthcare professional. Some example of food includes:

&nbsp;

<ol>
	<li>
	<h6>&nbsp;Complex Carbohydrates</h6>
	</li>
</ol>

Foods like oats, whole grains, and legumes provide a balanced source of energy throughout the day.

<ol start="2">
	<li>
	<h6>&nbsp; Protein-Rich Foods</h6>
	</li>
</ol>

Foods like yogurt, eggs, and nuts provide essential amino acids needed for building and maintaining muscle mass, which is important for older adults.

<ol start="3">
	<li>
	<h6>&nbsp; Low-Fat Foods</h6>
	</li>
</ol>

Avoid high-fat foods like fried foods, high-fat meats, and pastries, which can cause indigestion and increase cholesterol levels.

<ol start="4">
	<li>
	<h6>&nbsp; Hydration</h6>
	</li>
</ol>

Drink plenty of fluids like water, milk, and unsweetened juices to stay hydrated.

<ol start="5">
	<li>
	<h6>&nbsp; Fiber-Rich foods</h6>
	</li>
</ol>

Foods like fruits, vegetables, and whole grains are high in fiber and can help promote healthy digestion and prevent constipation, which is common in older adults. 
&nbsp;

In addition to following these suggestions, older persons should make an effort to eat meals on a regular schedule to help keep their blood sugar levels constant and prevent overeating. Before making any dietary changes, it&#39;s vital to speak with a doctor or a trained nutritionist, especially if there is an existing health concern. Depending on the person&rsquo;s unique health requirements, they can offer advice that is tailored to them. 
&nbsp;

<h5>Sehr and Iftaar Food for Gastro/Digestion Compromised Patients</h5>

Patients with gastropathy should choose foods that are simple to digest and won&#39;t aggravate their symptoms during Ramadan. Complex carbohydrates, diets high in protein, low in fat, and hydration are crucial for Sehr. Dates and water are advised at Iftaar, along with a range of low-fat foods, portion management, and hydration. Also, it&#39;s critical to steer clear of things like caffeine, spicy meals, acidic foods, and carbonated beverages that might aggravate symptoms. 
&nbsp;

Portion control is essential for preserving a healthy weight and making sure the body gets the nutrition it needs. Overindulging during Iftaar and Sehr might result in bloating, indigestion, and weight gain. On the other hand, not eating sufficiently from Iftaar to Sehr can make one feel weak and tired.

&nbsp;

<h5>Ideal Portion Sizes For Sehr</h5>

The Sehr meal gives the body the energy it needs for the rest of the day. During Sehr, it&#39;s critical to eat enough food to maintain energy levels without becoming bloated or feeling unpleasant. A nutritious Sehr portion should include the following. 
&nbsp;

<ul>
	<li>One egg or one cup of yogurt counts as one serving of protein.</li>
	<li>One serving of complex carbs, such as a piece of whole grain bread or a cup and a half of oats.</li>
	<li>A cup of salad or a small apple counts as one serving of fruits or vegetables.</li>
	<li>One serving of wholesome fats, like a spoonful of nut butter or half an avocado.</li>
</ul>

&nbsp;

<h5>Ideal Portion Sizes For Iftaar</h5>

Iftaar is a meal that breaks the fast and replenishes the body with essential nutrients. It is important to consume enough food during Iftaar to provide energy for the remainder of the day. A healthy Iftaar meal should consist of:

<ul>
	<li>One serving of protein, such as a small chicken breast or a cup of lentils.</li>
	<li>One serving of complex carbohydrates, such as a cup of brown rice or a slice of whole-grain bread.</li>
	<li>One serving of fruits or vegetables, such as a cup of mixed fruit or a small salad.</li>
	<li>One serving of healthy fats, such as a tablespoon of olive oil or a handful of nuts. 
	&nbsp;</li>
</ul>

<h5>Tips For Portion Control</h5>

Here are some tips for controlling portion sizes during Sehr and Iftaar:

<ul>
	<li>Use smaller plates to make portions look larger</li>
	<li>Fill half of the plate with fruits and vegetables</li>
	<li>Use measuring cups to portion out carbohydrates and proteins</li>
	<li>Avoid eating too fast, as this can lead to overeating</li>
	<li>Listen to the body and stop eating when full 
	&nbsp;</li>
</ul>

Sehr and Iftaar are two important meals that provide essential nutrients to the body during Ramadan. Controlling portion sizes during these meals is crucial for maintaining a healthy diet and ensuring the body receives the necessary nutrients. By following the recommended portion sizes and tips for portion control, people can have a healthy and fulfilling Ramadan experience. 
&nbsp;

&nbsp;

<h5>Sehr:</h5>

<ul>
	<li>Consumed before dawn to provide energy and sustenance for the day ahead.</li>
	<li>This is typically a light meal, as overeating can cause discomfort during the day-long fast.</li>
	<li>Common Sehr foods include oatmeal, eggs, dates, and bread.</li>
</ul>

&nbsp;

<h5>Iftaar:</h5>

<ul>
	<li>Eaten at sunset to break the day-long fast during Ramadan.</li>
	<li>A time for celebration and communal gathering, often with friends and family.</li>
	<li>The meal includes a variety of dishes, such as samosas, dates, fruit, and soups.</li>
	<li>It is customary to break the fast with a sip of water or juice, followed by dates. 
	&nbsp;</li>
</ul>

[1] Nachvak SM, Pasdar Y, Pirsaheb S, Darbandi M, Niazi P, Mostafai R, et al. Effects of Ramadan on food intake, glucose homeostasis, lipid profiles, and body composition. Eur J Clin Nutr [Internet]. 2019;73(4):594–600.

[2] Nugraha B, Ghashang SK, Hamdan I, Gutenbrunner C. Effect of Ramadan fasting on fatigue, mood, sleepiness, and health-related quality of life of healthy young men in summer time in Germany: A prospective controlled study. Appetite. 2017;111:38–45.

[3] Gharbi M, Akrout M, Zouari B. Food intake during and outside Ramadan. EMHJ-Eastern Mediterr Heal Journal, 9 (1-2), 131-140, 2003. 2003;

Neelam Asad

Importance Of Insulin In Diabetic Care

Nearly 463 million people in the world are diagnosed with diabetes, out of which nearly 150-200 million people need insulin therapy for their health<a href="#accordion">[1]</a>.

If you have type 1 diabetes, you&rsquo;ll have to inject insulin on a regular basis to use glucose from meals and, basically, to survive. This is because your pancreas is no longer making any insulin or producing an insufficient amount of the hormone.

If you have type 2 diabetes, your body may be producing insulin, but due to the fact that you&rsquo;re overweight or inactive, it may not be utilizing the hormone properly. This is called insulin resistance. You may need insulin shots to help your body control high blood glucose levels or hyperglycemia.

About 5-10% of pregnant women develop gestational diabetes<a href="#accordion">[4]</a>&nbsp;If you have gestational diabetes, you may need to inject insulin as well to manage your blood glucose levels until the baby is born. 
&nbsp;

Understanding the importance of Insulin

Understanding the role of insulin therapy as part of diabetes treatment becomes a whole lot easier when you understand how the hormone typically works and what happens when you get diabetes. 
&nbsp;

<ul>
	<li>
	<h5>Regulating Blood Sugar Levels</h5>
	</li>
</ul>

When you eat or drink, your body breaks down the carbs into glucose, which is the primary source of energy for your body. This glucose enters the bloodstream, signaling the pancreas to release insulin. Insulin helps the blood sugar to enter the cells where it can be used as an energy source.

It also helps the blood sugar to be stored in the liver as glycogen for later use; in case of low insulin levels between meals, the liver releases this stored sugar, ensuring the blood sugar levels are within a narrow range. 
&nbsp;

As a result, the blood sugar levels in the bloodstream decrease and, accordingly, the insulin levels decrease, too.

The problem arises when there&rsquo;s a lot of blood sugar in the bloodstream. The pancreas either has difficulty keeping up with the rising blood sugar levels or the cells stop responding to all the insulin, which is why you need therapy. 
&nbsp;

<ul>
	<li>
	<h5>Preventing Diabetic Complications</h5>
	</li>
</ul>

Untreated high blood glucose can lead to various complications. This includes nerve damage, blindness, foot ulcers, kidney damage, heart disease, and stroke. There is lots of insulin in the bloodstream, too, instructing the liver and muscles to take up the excess blood sugar; when their capacity is full, the extra blood sugar is sent to fat cells and is stored as body fat, resulting in weight gain and increasing the risk of type 2 diabetes. Insulin therapy is crucial to managing blood sugar levels to reduce the risk of developing these life-threatening complications and also to maintain overall better health. 
&nbsp;

<ul>
	<li>
	<h5>Correcting Insulin Deficiency</h5>
	</li>
</ul>

Your body&rsquo;s immune system may mistakenly destroy the insulin-producing cells in the pancreas if you have type 1 diabetes. This leads to a complete deficiency of insulin. Some individuals with type 2 diabetes struggle when they don&rsquo;t have enough insulin or when other treatment options (e.g., oral medications) are not effective in controlling blood sugar. Insulin treatment supplements or replaces natural insulin with the aim to achieve normal blood glucose levels. 
&nbsp;

<ul>
	<li>
	<h5>Meal Scheduling</h5>
	</li>
</ul>

A lot of factors, including lifestyle and weight, influence your insulin therapy. Planning meals helps because you can then determine your insulin regimen (insulin pump therapy or multiple injections every day) according to the amount of carbohydrates you consume in a meal. It gives you the liberty to enjoy a varied diet along with better glycemic control. 
&nbsp;

<h5>Other Functions Of Insulin</h5>

Insulin is also involved in<a href="#accordion">[2]</a>:

<ul>
	<li>Modification of enzyme activity and the subsequent reactions in the body</li>
	<li>Management of the synthesis of lipids</li>
	<li>Uptake of potassium and amino acids by cells and regulate DNA replication and synthesis of proteins</li>
	<li>Management of the breakdown of lipids and proteins because of changes in fat cells</li>
	<li>Regulation of the excretion of sodium and fluid volume of urine</li>
	<li>Building muscle post-injury or sickness</li>
	<li>Enhance the memory 
	&nbsp;</li>
</ul>

Important!

<ul>
	<li>Starting insulin therapy can be frightening. Consult your doctor to know more about the type of insulin you need. Make sure you know how, when, and where to inject insulin, and also how to rotate your injection sites.</li>
	<li>Always keep a proper record of your insulin dose and your blood glucose levels.</li>
	<li>Insulin should be stored correctly for usage. Extreme (hot and cold) temperatures damage insulin.</li>
	<li>Proper disposal of syringes, lancets, pen needles, and cannulas is important.</li>
	<li>Inform a doctor if you need help adjusting your insulin doses. This change may be due to changes in diet, increased or decreased exercise, illness, medication, weight loss or weight gain, etc.</li>
	<li>Contact a doctor if you have any problems taking insulin or if you notice any side effects. 
	&nbsp;</li>
</ul>

Insulin is an important hormone that controls how tissues and cells absorb energy. Insulin shots are effective in counteracting the effects of insulin resistance or deficiency. While people with type 1 diabetes have to inject insulin for the rest of their lives, the majority of people with type 2 diabetes may not need it<a href="#accordion">[3]</a>. Regular blood sugar monitoring and close communication with healthcare providers are essential for optimizing insulin therapy and achieving optimal diabetes management. 
&nbsp;

[1] Buse JB, Davies MJ, Frier BM, Philis-Tsimikas A. 100 Years on: The impact of the discovery of insulin on clinical outcomes. BMJ Open Diabetes Research &amp; Care

[2] Smith Y. Insulin’s role in the human body. News.

[3] An overview of insulin. Medical News Today.

[4] Department of Health &amp; Human Services. Diabetes and insulin. Better Health Channel.

Shermeen Zuberi

Ramadan is regarded as one of the holiest months of the Islamic calendar. Muslims all over the world fast from daybreak until dusk, abstaining from all food and beverages. For Muslims everywhere, this is a period of introspection and self-discipline. However, people with <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes </a>may worry about how fasting might impact their health at this time. Contrary to common perception, if done properly and under medical guidance, fasting during Ramadan can be helpful for diabetics. 
&nbsp;

Benefits for Diabetics

For diabetics, fasting during Ramadan can be quite beneficial. One of the most significant benefits is that fasting can help control blood glucose levels, specifically for those with type 2 diabetes. When a person fasts, the body burns stored glucose for energy, which can help in reducing blood sugar levels. Moreover, fasting improves <a href="https://merisehat.pk/article/insulin-dose-and-timings">insulin </a>sensitivity, making it easier for the body to use insulin to regulate blood sugar levels. 
&nbsp;

Fasting during Ramadan has an immense amount of positive effects on overall health. It has been shown to improve cardiovascular health, boost brain function, and promote weight loss. Apart from that, fasting can also help reduce inflammation in the body, which has been linked to many chronic diseases. 
&nbsp;

Fasting during Ramadan should be done safely and under medical supervision, specifically for those with diabetes. People with type 1 diabetes who take insulin should consult with their healthcare provider to adjust their insulin dose and meal plan to avoid hypoglycemia (low blood sugar). Those with type 2 diabetes, who take oral medication or insulin, may also need to adjust their medication schedule to prevent hypoglycemia. Monitoring blood glucose levels regularly during fasting is crucial to ensure blood sugar levels stay within a safe range<a href="#accordion">[1]</a>. 
&nbsp;

Diabetics should schedule an appointment with their diabetologist at least 6-8 weeks before the start of Ramadan so their diabetes is stable<a href="#accordion">[1]</a>.&nbsp;Furthermore, this gives them a chance to discuss any change in dosage, warning signs of hypoglycemia, meal plans for Ramadan, and any other queries with their doctors. 
&nbsp;

Nutrition Management

Another important aspect for diabetics during Ramadan is planning meals. During Ramadan, Muslims typically consume two meals: sehri (eaten before dawn) and iftari (eaten at sunset). The large gaps between meals can cause their blood glucose levels to fluctuate. Therefore, it is important to eat a well-balanced and nutritious meal at both times. 
&nbsp;

Diabetics should aim to consume foods that are low in sugar and carbohydrates and high in fiber, protein, and healthy fats. It is also important to stay hydrated by drinking plenty of water and other non-sugary fluids between iftar and sehri.

Ramadan also offers an opportunity for diabetics to reflect and focus on their spiritual well-being. By fasting, diabetics can feel a sense of solidarity with fellow Muslims and strengthen their faith. They can also use this time to practice mindfulness, gratitude, and other spiritual practices that can help improve their overall well-being. 
&nbsp;

Although fasting during Ramadan can be challenging for diabetics, with proper management and care, it can also be a blessing. Fasting can help control blood glucose levels, improve insulin sensitivity, and have positive effects on overall health. By working with healthcare providers, carefully monitoring blood sugar levels, and planning nutritious meals, diabetics can still participate in the spiritual and cultural traditions of Ramadan while maintaining their health and well-being. 
&nbsp;

[1] Diabetes And Ramadan – Guidance For Fasting During The Holy Month. Diabetes And Ramadan – Guidance For Fasting During The Holy Month | Hull University Teaching Hospitals NHS Trust 2016.