Posted on April 28, 2018

With Ramadan approaching, Hamad Medical Corporation (HMC) is urging patients with chronic medical conditions, such as diabetes and hypertension, to speak with their doctor before beginning a fast. Specialists from across the healthcare provider’s network of hospitals say it is imperative that patients seek professional advice before making any changes to their diet and medication regimes.

Dr. Amr Mohammed Elmoheen, Consultant of Emergency Medicine at Hamad General Hospital, says that although patients who take daily medication can often have this safely adjusted, making changes without a doctor’s advice can lead to serious complications. He also urges patients with irritable bowel syndrome (IBS) and other chronic digestive and stomach conditions to take preventative measures by avoiding large meals, spices and fried and fatty foods, which may trigger symptoms.

“With Ramadan approaching, we are receiving requests from patients seeking advice about how they can adapt the timing and dosage of their medicine during the fasting period. It is important for patients to talk to their doctor before making any modifications as changes can affect the medicine’s efficacy and the appearance of side effects. Doctors and pharmacists work with patients to help prevent or minimize these effects. As an example, medications prescribed to be taken once or twice daily can normally be taken at Iftar or Suhoor, whereas medications that should be taken every six or eight hours may require a more complex solution that is best determined by a physician,” said Dr. Elmoheen.

Ms. Manal Musallam, Director of Diabetes Education at the National Diabetes Center at Hamad General Hospital says diabetics who choose to fast need to be aware of the potential health risks. She urges patients who plan to fast to talk with their doctors as early as possible before Ramadan begins, saying that while many diabetics can safely fast, modifications to diet, exercise, and medication routines are often required. “Type 2 diabetics who have poorly managed blood glucose levels, elderly patients with type 1 or type 2 diabetes who take insulin, pregnant women who take insulin, and breastfeeding mothers who have type 1 or type 2 diabetes are generally advised not to fast. Patients with long-term diabetes complications, such as kidney failure or heart disease, are also advised not to fast. Your doctor can help determine if it is possible for you to safely fast,” said Ms. Musallam.

She says it is important for patients with diabetes to monitor their blood glucose levels regularly and to drink adequate fluids during non-fasting hours. She recommends water over juice and sugary beverages or options that include stimulants, such as coffee and caffeinated soft drinks. She also advises that patients with diabetes should ensure they eat the Suhoor meal and while she recommends resting before Iftar, she says sleeping during this period should be avoided as some patients may be at risk for hypoglycemia. 

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“Patients with diabetes should speak with their doctor or health educator about when and how often they should check their blood glucose levels. As a general rule, a reading of 80-180 mg/dl post meal is considered normal and it is advisable to eat the Suhoor meal as late as possible. We also advise patients to refrain from strenuous workouts during Ramadan, particularly during the few hours before the sunset meal as this is when they are at risk for low blood sugar. Low-intensity activity is encouraged and performing prayers should be considered as part of the daily exercise program,” added Ms. Musallam.

According to Dr. Amar Salam, Senior Consultant Cardiologist and Head of the Cardiology Department at Al Khor Hospital, while it is necessary for heart patients to speak with their doctor before undertaking a fast, especially for patients who take medication, there is usually no negative effect for most cardiac patients.

“While fasting is not recommended for some heart patients, including those who have recently had a heart attack or heart surgery, and patients who have narrowing or inflammation of the aortic valve, research indicates that fasting is good for the heart. Fasting not only lowers one's risk for coronary artery disease and diabetes, but it can also cause significant changes in a person's blood cholesterol levels, increasing HDL-C, the ‘good’ cholesterol by 30 to 40 percent. However, it is important for patients to consult with their doctor, especially patients who take medication and will require timing and dosage modifications, and potentially an alternative medication,” says Dr. Salam.

Dr. Salam, who is also Associate Professor, College of Medicine, Qatar University, adds that heart patients are advised to eat small portions during meals and to avoid fatty, salty, and sugary foods and large quantities of beverages. He suggests patients who drink caffeinated beverages ease into Ramadan by reducing their consumption of tea, coffee, and other caffeinated beverages prior to Ramadan. He says going without caffeine for long periods of time during Ramadan can cause withdrawal symptoms such as migraines and can be a shock to the system.

Dr. Salwa Abuyaqoub, a Senior Consultant for Obstetrics and Gynecology at Women's Hospital, stressed the importance of pregnant women speaking with their doctor before deciding to fast. She says that many pregnant women are able to safely fast, but there are exceptions. “While many pregnant women can safely fast, it is not medically advisable for women who have pregnancy complications such as diabetes and high blood pressure to fast. If your doctor gives you permission to fast, take care to consume a healthy and balanced diet and drink sufficient amounts of water during non-fasting hours. Each year we see an increase in the number of pregnant women visiting our Emergency Departments during Ramadan due to fasting, and specifically dehydration,” says Dr. Abuyaqoub.

HMC is asking patients who are unable to attend their appointment, or can see a change in their schedules as a result of their Ramadan-related commitments, to please call Nesma'ak at 16060 so the appointment can be rebooked. This will also allow the appointment slot to be assigned to another patient.