Ramadan and Type 1 Diabetes

More caution and perhaps more restraint are necessary in breaking a fast than in keeping it. ~Mahatma Gandhi

You know what, I fasted (followed Rozas) for all 30 consecutive days during Ramadan last year! You may wonder why I’m bragging about it especially when millions of people around the world do it. But as a type 1 diabetic, it was quite a feat I tell you…and because so many people want to know, here’s how I achieved it. Though I am technically exempted from fasting, eating while my friends and family around me wouldn’t, felt not only uncomfortable but also lacking to say the least.

Having grown up in a semi-orthodox middle class family, and living in a tightly knit Bohra Muslim community, I have fond childhood memories of fasting during Ramadan. Fasting is considered very holy and purifying, it is in fact “a sin” to not fast during Ramadan. The best part for me were the celebratory Iftars (opening the fast), a small social feast everyday for 30 days culminating into a major one called Eid.

For 25 years I did not (or could not) do any fasts but something changed for me and gave me the courage to give it a shot against all odds!

Two years ago, I gave up gluten completely and began modifying my eating habits after reading about the endocrine system, nutrition science and how different foods behaved especially for a diabetic. These changes helped me tremendously with many health improvements. It gave me the confidence to try the much tabooed fasting for an insulin dependent diabetic who would hit hypoglycemias at the drop of a hat or a carbo-hat. 😉

To take my next step, I started searching the web for people like me who would have fasted and could guide me too, I found a few but unfortunately they too dissuaded me and at best suggested that I fast for a day or two and see how it went but definitely give a break and never go fasting at a stretch beyond 5 days.

When I say fasting, in my case it means eating and drinking only before sunrise and after sunset, which is almost 15 hours without consuming anything orally in the Mumbai heat. This would imply surviving on the 2 meals and maybe a snack before sleep like any other non-diabetic or an attempting type 2 diabetic would. Sounds discouraging?

To put things into perspective then, I thought of our ‘hunter-gatherer’ ancestors many centuries ago and how they could go without food for weeks or bare minimum food for even months (through harsh winters) and still have enough energy to make a hunt or survive the hostile conditions, all I needed was to mimic that cycle for 15 hours everyday for 30 days and voila! Jokes apart, it was my knowledge of nutrition and hormones that came to my rescue plus I had some terrific guidance from my Doctor (and friend) to plan this ahead.

Dietary fats in particular carry a lot of efficient energy plus help in producing the satiety hormone (Leptin). Read the above sentence twice and you’ll know the secret to my energy. But what’s better? I wouldn’t even feel hungry!

This epiphany structured my first meal (Sihori), the foods I would eat before sunrise played a key role. Along with a glass of Vegetable juice I would eat a 3 to 4 Eggs omelet with Cheese, Vegetables, Mutton mince or plain but always made in Ghee, in fact soaking in Ghee or Olive Oil. A meal high in fiber, fats, proteins and nutrients would keep me going without much catabolising my muscles, and of course a mug of Tea with a huge dollop of butter in it (try it, a masala chai with some butter tastes really good) as I also needed the saturated fats for absorbing the nutrients plus priming my hormone production so I could work through the day with minimal drop in energy without any substantial breaks. Finally, a lot of water to end the Sihori would keep me hydrated for as long as possible.

Don’t forget that having a dead pancreas makes it necessary to calibrate the basal at a level where it provides just enough insulin to not disrupt the supporting hormonal cycle required by the body and brains to function through the day. This is where regular blood glucose monitoring plays an extremely important role.

I was fortunate to be on an Insulin pump and in addition to that I also got onto a CGMS two days ahead of the fasting period. Unfortunately the CGMS takes a day to stabilise though still seldom accurate but gives a good sense of how your blood sugars move through the day and night, my pump would suspend itself when my blood sugars dropped below 65 mg/dl and I would manually resume it soon as my blood sugars crossed 85 mg/dl.

Monitoring my blood glucose.

The first 3 days gave me a good understanding where my basals needed to be at so I could fine tune it to keep my blood sugars between 70 to 150 mg/dl at all times. But to my dismay this cycle kept shifting post the 7th day onwards and my blood sugars would rather rapidly climb post 10 hours of fasting. I realised that the liver had begun releasing glycogen (it had started breaking down the fat in the body) for energy- the fat loss had begun! Now to maintain body weight and to avoid any delayed hypos, I included some carbohydrates with other nutrients as my Iftars but my Sihoris still remained constant and I realised that overall I was now taking 7% to 10% more insulin than what I had started with but still slightly lower than my daily average before Ramadan, not a happy situation but I kept going. Post the 10th day of Ramadan, I was no more on a CGMS besides checking my blood sugars before Sihori, once or twice during the day, before Iftar and before sleep.

During this month, I can’t be thankful enough of the support I received from my family, my mother and especially from my wife after her initial resistance (out of fear of course) who would painstakingly prepare my meals at odd hours and they all one by one would check on me all the time. Besides the regular Islamic prayers also gave me some physical exercise and the will to carry on. I would sometimes go for a walk after 90 minutes of breaking my fast but do nothing intense, definitely no Gym or Jog. And eat a light snack (mostly fruit, nuts or drink a cup of turmeric milk) before sleep.

But the most wonderful part about Ramadan fasting was its after-effects!

  • My HbA1c’s were still within the normal range.
  • I was able to lose some weight during Ramadan and was also waking up fresher in the mornings now.
  • Insulin sensitivity had improved as I was taking almost 12% to 15% lesser insulin for the same foods until 4 months despite of very little exercise.
  • Leptin sensitivity had improved too as I wasn’t as hungry or in need of as much food now.
  • My metabolism was faster as I had better energy levels than before and could burn fat with much ease.
  • I had learnt newer ways of meditation to manage stress better.
  • My legs were stronger and brains were sharper.

Another very important change it brought for me was that I could now eat only when I was hungry or in a hypo. The freedom of not needing/wanting to eat every two hours feels empowering and I am still cherishing it plus so looking forward to repeating it all over again this upcoming Ramadan and I am (with proof) a big believer of the science behind fasting now.

Warning: If you too are a diabetic and wish to fast, please consult your Doctor and discuss the benefits of doing so but if he still persists you against it then always listen to your Doctor. Besides what works for me may not work for you as we all are genetically unique.

10 Comments on this article

  • Jenny June 2, 2016
    This is truly very motivating! I'm going to try a more strict lent next time.

    Reply

    • MuslimKapasi June 6, 2016
      Thanks Jenny. Of course, go for it and if you too are a diabetic try putting CGMS patch a few days before the start of lent, it will not only help you to manage your blood sugars better but also give you many insights on your metabolic cycles through the days. My Doctor (Dr. Manoj Chawla, Ph.: 022-26302288) helped me with a very positive frame of mind, guidance and tools.

      Reply

  • Riya Gabaji June 3, 2016
    Wow ,soo well written and inspiring!!!! A detailed insight to the power of fasting and it's benefit!!!!!!! Superb.

    Reply

    • MuslimKapasi June 6, 2016
      Thank you so much! Need your prayers and wishes always! :)

      Reply

  • Jaagruti Didwania June 5, 2016
    It's really inspiring to know people who are successfully able to pull through scientifically logical (we know fasting has got more biological benefits than religious peace) but traditionally unpermitted processes. Well that's how the orthodoxy often breaks, for a diabetic or a non diabetic - through people who take up the challenge of making a success story. The facts that you have shared about creating combinations with fat are really helpful, though I still wonder how not having water worked for you. I wish you all the best for Ramadan 2016!

    Reply

    • MuslimKapasi June 6, 2016
      Thank you so much for your wishes, Jaagruti. So aptly said, there might be science behind restrain giving physical, mental and soulful health but only if done right. I think water is part of that practice of total restrain. However, I am not an expert on religions or religious practices but I think no religion ever prescribes suicide or self immolation besides also gives plenty of exemptions to people with conditions to not fast because its foundation is laid on good health first. I came across a few T1Ds who too were managing fasting but with untreated hyperglycaemias and hypoglycaemias... I would say to them that unless you have the necessary tools and wherewithal to do it, please don't!

      Reply

  • Panchyal June 5, 2016
    Well written and ofcourse traditional fasting is proved to show miracles from ages. Lest done in more reasonable and as scheduled in scriptures. Science beholds in culture and traditions. Out of box kudos it's T1DM.

    Reply

  • Bela June 25, 2016
    Very inspiring and informative Muslim! Well done.

    Reply

    • MuslimKapasi July 8, 2016
      Thanks Bela. I'm looking forward to some delicious and nutritious gluten free and organic foods suitable for diabetics soon from Herbivore. :)

      Reply

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