AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Discover the impact of fasting on insulin levels and learn expert tips for managing diabetes during Ramadan 2023. Explore insights on insulin resistance and the importance of a checkup before Ramadan 2024 for diabetic patients using insulin. | Meri Sehat

The Importance Of A Checkup Before Ramadan For Diabetic Patients Using Insulin

Humza Khizer

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Check Yourself Before You Wreck Yourself

Introduction

&ldquo;A checkup can tell your inside story&rdquo; is something we have seemed to have forgotten over time. Sometimes it is due to a family commitment, and sometimes it is because of a work commitment. We have reached a point when we won&rsquo;t go for a checkup even when we are not feeling well!

&nbsp;

But did you know there is a list of diseases that can be prevented, or caught on early, if proper routine <a href="https://merisehat.pk/page/sehat-scan/">health checkup</a> is done? For starters, a routine <a href="https://merisehat.pk/page/sehat-scan/">health screening</a> would allow you to track any mild symptoms that might not seem dangerous initially. It also allows your health care practitioner to look for diseases that are notoriously asymptomatic.&nbsp;

&nbsp;

People nowadays have honestly started to take their health for granted. They only visit their doctors once a disease has settled in. Some of us even want to challenge the illness and see how far we can take it before we need to get admitted!

&nbsp;

Like any other medication a healthcare practitioner may prescribe for treating the disease, a <a href="https://merisehat.pk/page/sehat-scan/">health checkup</a> is necessary for preventing it. And as many of us will agree, &ldquo;prevention is better than cure&rdquo;.&nbsp; &nbsp;&nbsp; 
&nbsp;

&nbsp;

Understanding The Importance Of Regular Medical Check Ups

It is important to understand that males and females have different types of bodies physiologically. Hence, screening is essential for a range of different diseases, and, in some cases, it is solely dependent on the gender or age.

<h5>Blood Pressure</h5>

If you are a male aged between 18 and 39, you should control your blood pressure by getting it checked once every 2 years. If during these checkups your upper pressure (systolic) is above 120 and the lower pressure (diastolic) is more than 80, the monitoring has to be on a yearly basis<a href="#accordion">[1]</a>.

&nbsp;

<h5>Cholesterol</h5>

Due to dietary and lifestyle habits, cholesterol monitoring becomes crucial, particularly for men. The recommended age for cholesterol screening is 35 for men with no known risk factors for coronary heart disease, and 20 for men with known risk factors for coronary heart disease. If there are any comorbidities involved, you should get it checked more often. However, if the results are normal, the screening could simply be repeated after a span of 5 years<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

<h5>Diabetes</h5>

Diabetes and hypertension often go hand in hand. So, if you are a known hypertensive patient, you are more likely to be screened for diabetes. HbA1c is usually tested along with the oral glucose tolerance test (OGTT).&nbsp;

&nbsp;

For OGTT, blood sugar levels between 141 mg/dL and 200 mg/dL (7.8 - 11.1 mmol/L) is considered impaired glucose tolerance, whereas a result above 200 mg/dl (11.1mmol/L) means the person is diabetic. A normal HbA1C level is below 5.7%, levels of 5.7% - 6.4% indicates pre-diabetic condition, and 6.5% or more is a strong indicator of diabetes<a href="#accordion">[2]</a>. After obtaining your medical history in detail, your healthcare practitioner will decide whether screening for certain infections, like syphilis, chlamydia, and HIV is important or not.

&nbsp;

<h5>Prostate Cancer</h5>

Regarding malignancies, there are some horrific statistics seen in men, which makes it all the more necessary for them to be screened on a routine basis. According to the American Cancer Society&rsquo;s estimates for prostate cancer in the United States, in 2022, 268,490 new cases were reported and 34,500 people lost their lives due to the disease. This is equivalent to 1 in 8 men, with increasing risk once they turn 65<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

The Prostate Cancer Early Detection Guidelines established by the National Comprehensive Cancer Network urges men above 45 years of age to get a screening done, and then plan a routine checkup according to the results.&nbsp;

&nbsp;

Prostate Specific Antigen (PSA) along with a digital rectal examination (DRE) is done to screen you for prostate cancer<a href="#accordion">[5]</a>. The PSA is a blood test to check for prostate specific chemicals, whereas the DRE is the insertion of a finger in the anus to feel the physical aspects of the prostate<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<h5>Bladder Cancer</h5>

Even though it&rsquo;s a disease of elderly, with the mean age being 73, bladder cancer is another malignant disease that is four times more prevalent in men compared to women<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Data collected by GLOBOCAN in 2018 estimated that 550,000 people were diagnosed with bladder cancer<a href="#accordion">[6]</a>. The screening method for bladder cancer is done by a basic urine detailed report and urine cytology which helps detect abnormalities.&nbsp;

&nbsp;

<h5>Colorectal Cancer</h5>

Colorectal cancer is yet another cancer which takes around 27,000 lives in the US alone each year.&nbsp;

&nbsp;

It is recommended that a colonoscopy be done as a screening method in men at the age of 45 years. A family history of malignancies makes the screening even more crucial<a href="#accordion">[5]</a>.&nbsp;&nbsp;

&nbsp;

<h5>Sexually Transmitted Infections&nbsp;</h5>

Men who have sex with women should get screening for:&nbsp;

<ul>
	<li>Chlamydia, gonorrhoea, syphilis, herpes, HIV, and hepatitis B and C&nbsp;</li>
</ul>

&nbsp;

Men who have sex with men should get screening for:&nbsp;

<ul>
	<li>Chlamydia, gonorrhoea, syphilis, herpes, HIV, HPV, anal cancer, and hepatitis B and C&nbsp;</li>
</ul>

&nbsp;

Women also need to be screened for their overall health. Reason being that a woman has to go through menstruation, pregnancies, and then post-menopause, all of which can cause multiple relevant health condition like dysmenorrhea, premature delivery, and increased risk of malignancies, respectively.&nbsp;

&nbsp;

Following are a few vitamins and minerals, and their recommended daily allowance which a woman can take to ensure optimal health<a href="#accordion">[7]</a>:

<ul>
	<li>Iron: For those aged 19-50 years, it&rsquo;s 18 mg/day whereas for those aged 51 and up, it&rsquo;s 8 mg/day</li>
	<li>Magnesium: If aged 19-30, then 310 mg/day; if aged 31 years and above, then 320 mg/day</li>
	<li>Vitamin D:&nbsp;If aged 1-70 years, 15 mcg/day (600 IU or international units)</li>
	<li>Vitamin C: 75mg/day</li>
	<li>Vitamin E: 15mg/day</li>
</ul>

&nbsp;

<h5>Lung Cancer</h5>

If you smoke one pack a day, it is necessary for you to be screened for lung cancer.&nbsp;Screening is done by a Computed Tomography (CT) and has to be done annually.&nbsp;

&nbsp;

<h5>Cervical Cancer</h5>

Cervical cancer is the 4th most common malignancy found in women worldwide. Around 604,000 new cases and 342,000 deaths were reported in 2020, with 90% of this data being sourced from low and middle income countries<a href="#accordion">[8]</a>.&nbsp;

&nbsp;

In order to screen a woman with cervical cancer, a Pap test is recommended every 3 years for women aged 21-65 years. A Pap smear test is one in which your health care practitioner takes samples from your cervix and evaluates them under a microscope.&nbsp;

&nbsp;

<h5>Breast Cancer</h5>

Another alarming malignancy in females is breast cancer. A total of 7.8 million cases, diagnosed between 2015-2020, made it the most prevalent cancer worldwide. In 2020 alone, there were 2.3 million women who were diagnosed and 685,000 deaths worldwide that occurred due to breast cancer<a href="#accordion">[9]</a>.&nbsp;

&nbsp;

Screening for breast cancer is done through mammography (an x-ray of your breast) every 2 years from the age of 50 years onwards<a href="#accordion">[10]</a>.&nbsp;

&nbsp;

<h5>Sexually Transmitted Infections&nbsp;</h5>

Women who are 24 years and older and sexually active should get screened for sexually transmitted infections like chlamydia, gonorrhoea, herpes, trichomoniasis, HIV, HPV, cervical cancer, hepatitis B, hepatitis C, and syphilis. Chlamydia screening particularly should be done every year once girls turn 24.&nbsp;

&nbsp;

Pregnant women should be screened for chlamydia, gonorrhoea, herpes, HIV, HPV, cervical cancer, hepatitis B, hepatitis C, and syphilis.&nbsp;

&nbsp;

Screening for diseases in children is another ball game and one that&rsquo;s quite important too.&nbsp;

&nbsp;

<h5>Severe Acute Malnutrition</h5>

Severe acute malnutrition (SAM), also known as severe wasting, is the most crucial form of undernutrition and has a mortality rate of 10-30%.&nbsp;

&nbsp;

Studies show that children in developing countries have a strong correlation of undernutrition and development outcomes. It should be noted that even if the child survives the undernutrition at the moment, it would have a drastic effect on adulthood, especially with regards to physical and cognitive development.&nbsp;

&nbsp;

According to the Pakistan Demographic Survey (2017&ndash;18), 37.6% of children under 5 years were stunted, with 17% severely stunted. Furthermore, 7.1% were found to be wasted, with 2% severely wasted and 23% were underweight<a href="#accordion">[11]</a>. Hence, it becomes necessary to monitor a child who is 5 years or under, to counteract any existing deficiencies .&nbsp;

&nbsp;

Developmental Screening Test II (Denver), also known as DDST II, is used to screen a child for his or her development. DDST II has 4 components: personal-social behavior development, fine motor development, language, and gross motor development.&nbsp;

&nbsp;

Apart from this, anthropometric measurements are also taken to check for physical development. Anthropometric measurements include height, weight, head circumference, body mass index (BMI), body circumferences to assess for adiposity (waist, hip, and limbs), and skinfold thickness.

&nbsp;

Conclusion

It can be settled from the statistics mentioned above that some diseases are silent killers and need to be identified as early as possible. Anything could happen to anyone, so the best way to look out for yourself is to give yourself a fair opportunity. Just going to your doctor reduces your risk by 50%. Some diseases like pancreatic cancers are usually symptomatic at advanced stages. However, if routine blood work is done, it can warrant for early on imaging and, hence, diagnosis. There can be a lot of examples like this, but the main question remains, “do you love yourself enough?”&nbsp;&nbsp;

Key Points

<ul>
	<li>A health screening routine allows to track any mild symptoms that might not seem dangerous initially.</li>
	<li>Screening is important for different diseases and in some cases it&rsquo;s solely dependent on the gender or your age.</li>
	<li>If you are a male, aged between 18 and 39, you should keep your blood pressure in check by getting it checked once every 2 years.</li>
	<li>The recommended age for cholesterol screening is 35 for men with no known risk factors regarding coronary heart disease, and 20 for men with known risk factors for coronary heart disease.</li>
	<li>Blood sugar levels between 141 mg/dL and 200 mg/dL (7.8 to 11.1 mmol/L) is considered impaired glucose tolerance, whereas above 200 mg/dl (11.1mmol/L) is diagnostic of diabetes in an OGTT.</li>
	<li>A normal HbA1C level is below 5.7%, whereas a level of 5.7-6.4% indicates pre-diabetes. 6.5% or more is a strong indicator of diabetes.</li>
	<li>2022 studies show 268,490 new cases were reported and 34,500 people lost their lives due to prostate cancer in the US.</li>
	<li>Prostate Specific Antigen (PSA) along with a digital rectal examination (DRE) are done to screen one for prostate cancer</li>
	<li>Bladder cancer is 4 times more prevalent in men compared to women.</li>
	<li>Data collected by GLOBOCAN in 2018 estimated that 550,000 people were diagnosed with bladder cancer.</li>
	<li>The screening method for bladder cancer is a basic urine detailed report and urine cytology.</li>
	<li>Colorectal cancer is the 4th most common cancer in the US which takes around 27000 lives each year.</li>
	<li>Colonoscopy should be done to screen men around 45 years.</li>
	<li>Women need to tend to their overall health as vigilantly as possible, to ensure proper menstrual cycle and pregnancies.</li>
	<li>Lung cancer screening is done by a Computed Tomography (CT) and has to be done on an annual basis.</li>
	<li>Cervical cancer is the 4th most common malignancy found in women worldwide. Around 604,000 new cases were reported in the year 2020 and 342,000 deaths, with 90% of this data being sourced from low- and middle-income countries.</li>
	<li>Pap test is recommended every 3 years for women aged 21-65 years, for screening for cervical cancer.</li>
	<li>In 2020 alone, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally.</li>
	<li>Screening for breast cancer is done by mammography every 2 years from the age of 50 years.</li>
	<li>Sexually active men (included males who have sex with males) and women (including pregnant women) should get screened for sexually transmitted infections.</li>
	<li>According to the Pakistan Demographic Survey (2017&ndash;18), 37.6% of children under 5 years of age were stunted, with 17% severely stunted. Furthermore, 7.1% were found to be wasted, with 2% severely wasted, and 23% were underweight.</li>
	<li>Developmental Screening Test II (Denver), also known as DDST II, and anthropometric measurements are used to screen a child for his or her development.</li>
</ul>

&nbsp;

[1] Health screenings for men ages 18 to 39: Medlineplus Medical Encyclopedia. MedlinePlus.

[2] All about your A1C. Centers for Disease Control and Prevention.

[3] Key statistics for prostate cancer: Prostate cancer facts. American Cancer Society.

[4] What is screening for prostate cancer? Centers for Disease Control and Prevention.

[5] 5 most common cancers in men. Roswell Park Comprehensive Cancer Center.

[6] Saginala K, Barsouk A, Aluru JS, Rawla P, Padala SA, Barsouk A. Epidemiology of Bladder Cancer. Med Sci (Basel). 2020;8(1):15. Published 2020 Mar 13. doi:10.3390/medsci8010015

[7] Vitamins and minerals: How much should you take? WebMD.

[8] Cervical cancer. World Health Organization.

[9] Breast cancer. World Health Organization.

[10] What is a mammogram? Centers for Disease Control and Prevention.

[11] Saleem, J., Zakar, R., Bukhari, G.M.J. et al. Developmental delay and its predictors among children under five years of age with uncomplicated severe acute malnutrition: a cross-sectional study in rural Pakistan. BMC Public Health 21, 1397 (2021).

Arbaz Ansari

Ramadan is a holy month for Muslims all over the world. It involves fasting from sunrise to sunset and it can be challenging for individuals with <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a>, especially those who rely on insulin to manage their condition. However, with the right guidance and precautions, it is possible for diabetic patients to fast for e.g. In a multi-centric study of diabetic patients, it was discovered that 42.8% of those with type 1 diabetes and 78.7% of those with type 2 diabetes fasted for a minimum of 15 days <a href="#accordion">[1]</a>. 
&nbsp;

To ensure their safety and well-being, it is crucial for diabetic patients using insulin to schedule a checkup with their healthcare provider before Ramadan begins. 
&nbsp;

Fasting during Ramadan alters the meal and sleep schedules of Muslims. This can affect their body&#39;s natural processes and hormones. Changes in sleep patterns can affect their body temperature and cortisol levels. 
&nbsp;

In diabetics, fasting causes the body to break down glycogen and produce ketones. This can make it harder to control their blood sugar levels and may lead to serious complications like dehydration, blood clots, or ketoacidosis<a href="#accordion">[2]</a>.

The pancreas secretes the hormone insulin, which controls the body&#39;s blood sugar levels. It enables glucose to enter cells, so it can be stored or used as fuel later. In diabetics, there may be a complete deficiency of the hormone or there may be insulin resistance. Therefore, diabetics may require the hormone in a drug form to help control blood sugar levels. 
&nbsp;

Importance of Checkup

It is crucial for diabetic patients taking insulin to consult their doctor before Ramadan starts. The doctor will evaluate the patient&#39;s current health throughout the examination and change their insulin dosage if necessary. This is crucial because, throughout Ramadan, the patient&#39;s diet, activity level, and sleeping habits may alter, changing their insulin needs. 
&nbsp;

<ul>
	<li>
	<h5>Adjusting Medication Dosage</h5>
	</li>
</ul>

To assure that the patient&#39;s glucose levels remain steady throughout the day, the healthcare professional may modify the insulin dose according to the patient&#39;s condition and specific needs. 
&nbsp;

<ul>
	<li>
	<h5>&nbsp;Identifying Potential Complications</h5>
	</li>
</ul>

The doctor can perform tests to look for any indications of diabetes-related problems, such as diabetic retinopathy or neuropathy, and can also take preventative steps. The doctor will evaluate the patient&#39;s health status during the visit, including their blood sugar levels, HbA1C level, and any further medical conditions they might have. This can help determine if the patient is healthy enough to fast during Ramadan. 
&nbsp;

<ul>
	<li>
	<h5>Providing Guidance On Food Choices</h5>
	</li>
</ul>

In order to ensure stable blood sugar levels throughout the non-fasting hours, the doctor might offer advice on healthy food selections. 
&nbsp;

<ul>
	<li>
	<h5>&nbsp;Educating The Patient</h5>
	</li>
</ul>

Doctors can help the patient to learn how to check blood sugar levels while fasting, how to identify hypo or hyperglycemia, and what to do when faced with an emergency. 
&nbsp;

<ul>
	<li>
	<h5>&nbsp;Ensuring Overall Health</h5>
	</li>
</ul>

Before beginning the fasting period, a checkup helps guarantee that the patient&#39;s overall health is at its best. In addition to ensuring that the patient may completely observe Ramadan while treating their diabetes, this can help prevent complications. 
&nbsp;

Telehealth can be a useful tool for diabetic patients to seek a first opinion or medical advice before Ramadan. It offers a convenient, accessible, and cost-effective way for patients to communicate with their healthcare provider and ensure they are adequately prepared to manage their diabetes during the holy month. It is also recommended to have an in-person meeting with your doctor as they are familiar with your medical history and current medical condition. 
&nbsp;

Risks

Fasting can result in hypoglycemia (low blood sugar levels) which, in severe circumstances, can be fatal. The risk of fasting includes<a href="#accordion">[3]</a>. 
&nbsp;

<ol>
	<li>
	<h5>&nbsp;Hypoglycemia</h5>
	</li>
</ol>

For diabetic patients receiving insulin, this poses a special risk because insulin can further reduce blood sugar levels. The symptoms of hypoglycemia include lightheadedness, confusion, and even unconsciousness. Patients with type 2 diabetes experience significantly lower rates of hypoglycemia than those with type 1 diabetes. Type 2 diabetics using oral medications experience even lower rates. 
&nbsp;

<ol start="2">
	<li>
	<h5>&nbsp;Hyperglycemia</h5>
	</li>
</ol>

Fasting can occasionally result in hyperglycemia or elevated blood sugar. Several factors, such as stress, might cause this. Hyperglycemia may result in symptoms, such as fatigue, increased thirst, and blurred vision. 
&nbsp;

<ol start="3">
	<li>
	<h5>&nbsp;Diabetic Ketoacidosis</h5>
	</li>
</ol>

Diabetes can cause a potentially fatal complication known as diabetic ketoacidosis (DKA). It happens when the body creates large quantities of blood acids called ketones, which can accumulate in the blood and harm organs. In diabetic patients taking insulin, the reduction of insulin dosages during fasting increases the risk of DKA. 
&nbsp;

According to recommendations, patients with type 1 diabetes have a high chance of developing diabetic ketoacidosis (DKA). Fasting is typically not recommended for Type 1 diabetic persons with an HbA1c level of more than 9%, those who are pregnant, have renal impairment, macrovascular problems, or are prone to experiencing hypoglycemia. The same guidelines apply to Type 2 diabetics. 
&nbsp;

However, under supervision, with good compliance and backup assistanceType 1 and type 2 diabetics can fast successfully. 
&nbsp;

Diabetics using insulin who aim to fast need to take a number of precautions to reduce their risk of complications. 
&nbsp;

<ol>
	<li>
	<h5>&nbsp;Consult With Your Doctor</h5>
	</li>
</ol>

It is crucial to speak with your doctor prior to fasting. They can offer advice on how to modify your insulin dosage and keep an eye on your blood sugar levels, as well as assist you to decide whether fasting is appropriate for you. 
&nbsp;

<ol start="2">
	<li>
	<h5>&nbsp;Monitor Your Blood Sugar Levels</h5>
	</li>
</ol>

It&#39;s crucial to regularly check your blood sugar levels while fasting. This can assist you in immediately recognizing and responding to any variations in your blood sugar levels. Your doctor might advise more regular blood sugar checks throughout the fast. 
&nbsp;

<ol start="3">
	<li>
	<h5>&nbsp;Adjust Your Insulin Dosage</h5>
	</li>
</ol>

A change in insulin dosage during fasting may be advised by your doctor. By doing this, the risk of both hypo and hyperglycemia can be reduced. Also, your doctor may advise adjusting the times of your insulin shots to match the hours when you&#39;ll be eating. 
&nbsp;

<ol start="4">
	<li>
	<h5>&nbsp; Recommendations For Diet and Exercise</h5>
	</li>
</ol>

The doctor may suggest modifying the patient&#39;s diet and exercise regimen in addition to altering the insulin dosage. For instance, they may advise the patient to eat more complex carbohydrates at their suhoor meal to keep their blood sugar levels stable throughout the day. In order to prevent hyperglycemia, they might also advise the patient to do some mild exercise after Iftar. 
&nbsp;

To safeguard their safety and well-being during Ramadan, diabetic people who need insulin must take extra care. Pre-Ramadan evaluations with healthcare professionals are recommended for all diabetic patients who intend to fast, ideally 6&ndash;8 weeks prior to the start of Ramadan. This gives the patient adequate time to analyze their medical history, assess their risk of fasting, and create a Ramadan management strategy. 
&nbsp;

Key Takeaways

<ul>
	<li>As it necessitates considerable adjustments in eating, sleeping, and activity routines, the Ramadan fast can be extremely difficult for diabetic individuals using insulin.</li>
	<li>Before Ramadan, diabetic individuals who use insulin should consult with their doctor to review their blood sugar levels, medicine dosage, and insulin regimen in order to avoid hypoglycemia (low blood sugar) during fasting.</li>
	<li>Before Ramadan, a thorough medical examination can aid in identifying any underlying health conditions, such as kidney or liver difficulties, that may compromise the patient&#39;s capacity to fast.</li>
	<li>To prevent issues with fasting, such as hyperglycemia (high blood sugar) or ketoacidosis, careful blood sugar monitoring is essential during Ramadan.</li>
	<li>Patients should get educated on the potential complications of fasting as well as tips for controlling their diabetes throughout Ramadan, including the right dietary changes, exercise regimens, and medication alterations.</li>
	<li>If a diabetic patient notices any signs of hypoglycemia or hyperglycemia while fasting, they must immediately seek medical attention. 
	&nbsp;</li>
</ul>

[1] Benaji B, Mounib N, Roky R, Aadil N, Houti IE, Moussamih S, et al. Diabetes and Ramadan: review of the literature. Diabetes Res Clin Pract. 2006;73(2):117–25.

[2] Bahijri S, Borai A, Ajabnoor G, Abdul Khaliq A, AlQassas I, Al-Shehri D, et al. Relative metabolic stability, but disrupted circadian cortisol secretion during the fasting month of Ramadan. PLoS One. 2013;8(4):e60917.

[3] Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895.