With fasts lasting nearly twenty hours what should you do to prepare? By Maqsud Patel.

Certain groups of patients are exempt from fasting including people with sickness or certain medical conditions.

It is important that those who decide to fast especially patient with diabetes, are provided information to support them and reduce the risk of complications.

Normally our body`s main energy source is obtained from the glucose stored in the liver and muscles.

However, as the fasting time period this year will be approximately 20 hours, the body will require extra energy which the body uses from the fat stores once the main store is used up. This can be beneficial as the use of fat for energy will lead to weight loss and hence better control of medical conditions such as diabetes and blood pressure. Hence, the choice of food we consume during meal times will support our energy needs throughout the day.

Dietary Advice During ramadhan our meal times change with the two main meals being Sehri (dawn) and Iftari (sunset).

These meals, particularly the iftari meal, are characterised by large quantities of high calorie foods and sugary drinks including fried food and sweet foods . It is important to ensure that during iftari meal, more fruit, vegetables and starchy food are consumed. Replacing much needed fluids is very important between the two meals.

It is important not to skip the dawn / Sehri meal. Diabetics need to ensure at sehri they eat more starchy foods that release energy slowly and are rich in fibre. Examples of such foods are: Wholegrain bread, beans, milk, porridge, oats, boiled rice, pasta, cereals, potatoes. Try to eat fruit and vegetables and drink plenty of fluids.

The main meal should remain very much a balanced dish containing foods from all the major food groups.

As the medication for diabetes is so varied for individuals, it is recommended you speak to your Doctor or pharmacist at least one month before Ramadhan starts to discuss any issues. If you are taking insulin then you should consult your doctor to see if your dose needs adjustment to allow fasting. Regular self- monitoring of your blood glucose levels is important.

If you experience low blood glucose levels (hypoglycaemia) with symptoms such as sweating, confusion, dizzy looking pale / tired then this should be treated immediately.

You should have a high sugar containing drink, 3-4 glucose tablets or 3-4 lumps of sugar immediately and then seek medical advice if symptoms do not improve.

It is possible for patients with diabetes to fast but they should discuss this and make careful planning to avoid any complications.

I recommend that they discuss their suitability to fast and the relevant adjustments to medications with your Doctor, Diabetic nurse, local imam or Pharmacist.

The month of Ramadan should be seen as an opportunity to not only gain benefit spiritually but also make long term changes towards a healthier lifestyle Maqsud Pael is a pharmacist at the Whalley Range Pharmacy.