"It is frustrating," shares an exasperated banker, Radin Ali. "Ramadan is almost over and I still want to take advantage of this month but my diabetes makes it so very exhausting." In a different household, housewife Sitara Shah complains, "I've had to break a few fasts — I get very hungry very fast, and I start feeling dizzy halfway through the day. It's almost as if I can feel my sugar levels drop."

These are not isolated incidents — diabetes can really bring one down to their knees especially during Ramadan by causing their blood sugar levels drop, making one feel more fatigued and weaker. However, Ramadan is a much-anticipated month for all Muslims and nobody wishes to miss out on its blessings. Chowdhury Tasneem Hasin, Principal Dietician for United Hospital Limited, feels that while it may seem impossible at first glance, with a few tweaks to your diet and lifestyle, there is no reason why it should not be possible for diabetics to conquer all the above issues and fast in a healthy and safe manner.  

Diabetes means when a body is unable to control its sugar levels. When a diabetic patient eats sweets, even in negligible quantities, their sugar levels rise and when they go without food for a prolonged period of time, their blood sugar can fall steeply. A sharp drop in the blood sugar of a person can cause hypoglycaemia which is lethal, which is why diabetic patients must be cleared by their doctors before opting to fast. As a clinical dietician, Tasneem believes that diabetic patients who wish to fast should start monitoring their sugar levels regularly. They must know which parts of the day their sugar levels could spike and what times remain stable. "A person with uncontrolled diabetes cannot hope to fast unless they control their diet strictly."

A diabetic's diet must contain a serving of leafy or regular vegetables, a first-class protein like eggs, fish or meat, complex carbohydrates like brown rice, wholewheat or brown bread to keep patients like Sitara fuller for longer and keep hunger at bay, about two servings of dairy in any form, and dates. "4 to 5 pieces of dates will go a long way to ensure high energy levels for diabetes patients who feel exhausted easily, and help them avoid hypoglycaemia through the day," says Tasneem.

Their iftars and sehris must also be properly planned and not be overly oily or fried. "Chickpeas are great for diabetic patients — they are a second-class protein as they also have fibre. It is not advisable to have too much lentil as that can throw off creatinine levels. Something sweet must form a part of their meal but instead of eating food with too much refined sugar, they can opt for milk-based desserts sweetened with honey or dates." 2 to 2.5 litres of fluids spaced out between iftar and sehri is optimum. Tasneem swears by coconut water as opposed to fruit juices. "It is less sweet and is packed with potassium which helps us rehydrate faster."

Some people tend to skip dinner during Ramadan as they feel two meals a day, sehri and iftar will be enough for them to last through the day. This is a big no-no for a diabetic patient. Insulin is a hormone responsible for metabolising fats, carbohydrates and protein. When a diabetic person eats a big meal like iftar, the insulin produced in their body is not enough to metabolise it and their sugar levels go off the charts. This is why big meals such sehri or iftar should be spaced out over a long period of time and eaten slowly so that the existing insulin levels can help break this food down. "4 to 5 meals is preferred for such patients and they must break their meals down accordingly. If such a patient skips dinner, they must eat more during iftar and sehri, which can be detrimental to them. They must take dinner, even if it is a light one." Options for light dinners include yoghurt, which contains a lot of probiotics, light dinners like salads with lots of lettuce or other leafy greens, with a side of milk, or even a bowl of oatmeal with eggs and nuts. 

It is not just about their food, but their lifestyle in general. Diabetic patients should never lay down right after having food. A break of at least 40 minutes is advisable, entailing household work or light exercises. "I believe if a diabetic patient can do their 20 rakaats of Tarawih prayers every day, that could be optimum exercise for them."

There you have it — diabetic or not, Ramadan can be for everyone. Heath and religion do not have to be mutually exclusive. Eating healthy off the bounties of the Almighty can lead to a hearty, happy and sugar-controlled Ramadan that leaves you as full of energy as it found you.