Diabetes and Hypertension – Overcoming Ailments in Ramadan

For those with chronic illnesses, such as high blood pressure and diabetes, fasting presents specialized physiological challenges. Long-duration fasting disrupts metabolic functions, affecting blood sugar maintenance, blood pressure stability, and kidney function. Proper planning, medical monitoring, and lifestyle modifications can enable fasting to be observed with minimal risks to overall health. Preplanning with a hospital in Dubai can provide customized advice per individual medical needs.

Physiological Impacts on Diabetes

Diabetes, particularly type 1 and 2, is characterized by dysfunctional blood glucose management. Long-duration fasting impacts insulin sensitivity, glycogen storage, and glucose metabolism, with a risk of leading either toward hypoglycemia (abnormally lowered blood sugar level) or hyperglycemia (abnormally elevated blood sugar level). Furthermore, in insulin-dependent diabetics, diabetic ketoacidosis (DKA), a life-threatening condition resulting from insulin deficiency, is also a possibility.

1 Management of Glycemia

◦ Suhoor Meal: A balanced Suhoor meal should consist of low-glycemic index (GI) carbohydrates (such as oats, quinoa, or lentils), lean proteins, and healthy fats. These foods release glucose slowly, helping reduce the risk of hypoglycemia.

◦ Dosage Modification and Insulin Therapy: The dosage of oral hypoglycemic drugs or insulin must be modified with an endocrinologist consultation. Insulin regimens also need modification, changing basal-bolus to a combination of rapid-acting and long-acting insulin at Iftar.

◦ Frequent Blood Glucose Monitoring: Monitoring blood glucose frequently (before Suhoor, midday, before Iftar, and two hours after Iftar) can prevent critical fluctuations. If blood glucose is < 70 mg/dL or > 300 mg/dL, early medical care is necessary.

◦ Identification of Hypoglycemia and Hyperglycemia: Symptoms indicating hypoglycemia are excessive sweating, lightheadedness, and confusion, which should prompt immediate breaking of the fast. In comparison, chronic fatigue, excessive thirst, and blurred vision are signs of hyperglycemia.

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The Effects of Fasting on Hypertension

Hypertension, or high blood pressure, is inextricably bound with fluid balance, blood vessel resistance, and electrolyte homeostasis, which can be affected by prolonged fasting. Inadequate water intake, excessive sodium intake, and overeating after breaking the fast can cause blood pressure fluctuations, with a resultant increased risk of hypertensive and cardiovascular emergencies.

Maintaining Blood Pressure Stability

• Timing and Dose Titration with Medication: Medication dosages may require adjustment. This advice is not a substitute for consultation with a healthcare practitioner. Consult a healthcare practitioner before making changes.

• Potassium-Based Diet: Potassium counteracts sodium, keeping blood pressure stable. Suhoor and Iftar foods high in potassium include avocados, spinach, bananas, and yogurt.

• Avoiding Spikes in Blood Pressure After Fast: A high-salt food intake immediately after Iftar can cause fluid shifts, leading to a hypertensive reaction. To counteract this, break Iftar with water-retentive foods and complex carbohydrates, followed by the gradual addition of protein foods.

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Special Considerations for Women with Diabetes and Hypertension

Women, particularly those who are pregnant, breastfeeding, or have hormonal imbalances, are at increased risk. Fluctuations in estrogen and progesterone can impact blood pressure stability and insulin sensitivity.

• Management of Gestational Diabetes: Pregnant women with gestational diabetes are advised to have regular fetal and blood sugar monitoring. If fetal distress or maternal hypoglycemia occurs while fasting, religious exemptions are warranted. Insulin resistance is also seen in women with PCOS, which tends to accentuate blood sugar fluctuations during fasting. A high-fiber, high-protein, carbohydrate-controlled intake can reverse metabolic imbalance. Consulting a gynecologist in Dubai as soon as discomfort is felt is ideal.

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Exercise And Lifestyle Modifications During Ramadan

Fasting changes energy production in metabolism, making exercise regimens a consideration. Although regular activity is good for cardiovascular and blood sugar control, excessive activity can cause hypoglycemia or dehydration. Light activities like walking, stretching, and yoga are more suitable than high-intensity training, particularly before Iftar.

Hydration and Balancing Electrolytes

Dehydration exacerbates diabetic complications and hypertension. Drinking water consistently between Iftar and Suhoor is more effective than consuming large amounts at once. Foods with high electrolyte concentrations, such as watermelon, cucumber, and coconut water, can be used to maintain fluid balance.

The kidneys play a role in maintaining blood pressure and carbohydrate (glucose) metabolism. Diabetics and hypertensive individuals are at risk for nephropathy (renal disease), so healthy kidneys are a high-priority consideration during fasting.

Protecting Kidney Function

• Monitoring Urine Flow: Low output, dark-colored urine, or edema in the extremities can be signs of kidney overwork or early signs of dehydration-induced kidney impairment.

• Proteins in Moderation: Proteins are essential, but excess from red meat sources or highly processed foods can lead to excess renal load. Use lean proteins from sources such as eggs, tofu, or fish.

• Routine Renal Function Tests: Individuals with established chronic kidney disease are encouraged to have regular screening with creatinine and glomerular filtration rate (GFR) before and after Ramadan.

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Balancing Faith with Knowledge

Diabetics with hypertension require careful preparation and monitoring by a healthcare provider. A planned approach to blood sugar management, blood pressure, and kidney health can enable diabetics with hypertension to fast safely. A cardiology specialist or urology in Dubai can provide specialized medical advice on fasting with minimal risks. Proper planning, in consultation with a specialist, allows diabetics with hypertension to observe Ramadan in a way that is both healthy and spiritually fulfilling.