Frequently Asked Questions About Ramadan and Diabetes - ICLDC answers these queries!

1.    Can I fast during Ramadan if I have diabetes?

For the majority of people with type 2 diabetes it is perfectly safe to fast during Ramadan provided that you prepare well and talk to your doctor. However it is not safe for everyone with diabetes to fast. Your ability to safely fast will depend on your medication. It will also depend on how well your diabetes is controlled, especially if you’re prone to either frequent high (Hyperglycemia) or low blood sugar levels (Hypoglycemia).

You must realise the importance of your medical assessment before you start, especially if you are taking any medication. Your doctor will guide you to create a fasting plan which works for you.

People with type 1 diabetes are at a higher risk compared to those with type 2 diabetes when fasting during the Holy Month of Ramadan.

It is very important that as a type 1 diabetes patient intending to fast you should be closely supervised and have your blood sugar regularly monitored to mitigate health risks.

2.    Do I need to go on a special diet during Ramadan, if I have diabetes?

No, you do not need to eat differently. In fact you should eat normally with the only difference being the time you eat rather than quantity or type of food consumed.

ICLDC’s nutritionist Rahma Al Ketbi says that the Ramadan diet should be kept simple and not much different from your normal daily diet. It should contain foods from all the food groups including:

Bread, cereals or rice

Meat, chicken, fish or beans

Milk, laban or yogurt

Fruits and vegetables

Iftar is the meal that breaks the fast, just after sunset. It comes after the long hours of fasting. However, it is important that it remains a meal and not become a feast!

You must also be very aware of the need to drink enough to remain hydrated during fasting hours.

One other thing to be particularly aware of is the risk of increasing blood sugar levels after iftar, especially with sweet foods.

3. How many people have diabetes, worldwide, and where does the UAE rank?

2012 figures from the International Diabetes Federation (IDF) suggest that 371 million people are living with diabetes, worldwide.

In the UAE, diabetes currently affects 18.9 per cent of the population, placing the nation eleventh worldwide for countries with the highest diabetes prevalence per capita.

It is also important to note that diabetes is a regional challenge. Saudi Arabia, Bahrain, Kuwait and Qatar all feature in the top ten countries, worldwide.

These statistics indicate that the region has high risk factors for diabetes, mostly related to rising obesity rates and physical inactivity.

Indeed, rapid economic growth, sedentary lifestyle and unhealthy diet have all contributed to increased obesity and have fuelled diabetes prevalence in the region. It is important that we stay focused on educating region-wide populations on the management and prevention of diabetes.

4. What is the age range of people affected?

People of most ages are affected by diabetes.

Type 1 diabetes is an auto-immune condition where the pancreas is attacked by auto-antibodies causing it to fail. It mostly develops before adulthood in younger people and remains with them throughout their life.

Type 2 diabetes on the other hand is mainly brought on by an unhealthy, inactive lifestyle, weight gain and genetics. Obesity is known to increase the risk of developing type 2 diabetes in adulthood.

However with the rise in childhood obesity in recent years, the picture has changed. Recent statistics show that 10 per cent of children and adolescents - between 16 and 17 years old, suffer from obesity, worldwide. In the UAE, figures suggest that a third of the population is obese, with many of those school children.

Indeed, there has been an increase of type 2 diabetes in younger people due to obesity linked to physical inactivity and unhealthy diets.

5. Which group of people is most affected age/gender etc?

Most people living with diabetes are between 40 to 59 years, although recent research is showing a worrying rise among younger age groups.

As for gender distribution, the estimates for both 2003 and 2025 showed a female predominance in the number of persons with diabetes. The female numbers were about 10 per cent higher than for males.

There was also a female predominance in the number of persons with pre-diabetes in the estimates for both 2003 and 2025. The female numbers were about 20 per cent higher than for males.

6. We are seeing more children with type 2, even though it normally only appears in adults over the age of 40; Why is that?

Research has indicated that type 2 diabetes is mainly brought on by an unhealthy, inactive lifestyle and weight gain. In recent years, we have seen a (rapid) spread over all age groups.

Among children, type 2 diabetes is fast becoming recognised as a global public health issue with potentially serious health outcomes.

In the UAE we are hopeful that through our public health awareness campaign ‘Diabetes-Knowledge-Action’, we will be able to help children and adults alike living with, or at the risk of developing diabetes. Also through research we hope to determine why diabetes occurs at such high levels in the country and instigate further preventative measures.

7. How many people are believed to have diabetes but are undiagnosed?

According to the International Diabetes Federation’s Diabetes Atlas in 2012, around half of the estimated 371 million people with diabetes worldwide were unaware they had it.

There is a similar trend in the UAE as the IDF estimates that just under half of the people with diabetes are unaware that they have the disease.

8.    What are the main causes of diabetes in the UAE e.g the triggers and factors contributing to diabetes?

Diabetes is a condition that is characterised by an above normal level of glucose (sugar) in the blood.

It is characterised by either a relative or absolute deficiency of insulin. 

This is because the pancreas does not make enough insulin or insulin becomes ineffective. Insulin, a hormone generated in the pancreas, normally controls blood sugar levels and allows the glucose to enter the cells in the body to provide energy. In type 2 diabetes resistance to insulin is aggravated by obesity.

In people with diabetes, high levels of glucose remain in the bloodstream causing hyperglycaemia (high blood sugar).

Those at increased risk include individuals who have a history of diabetes in their family, people over 40, those who are overweight or obese and inactive individuals.

Many people with type 2 diabetes are overweight and obese and this is an important factor in causing diabetes.

9. Is diabetes a big concern in the UAE - and why?

Yes, diabetes has generally been on the rise in the UAE. According to the International Diabetes Federation’s World Diabetes Atlas 2012, the UAE is ranked 11th worldwide, with 18.9 per cent of the UAE population living with diabetes

There seems to be a genetic predisposition to the disease among UAE nationals and statistics show that they have a higher prevalence than other nationalities within the UAE.

Tendencies towards an inactive lifestyle, weight gain, an imbalanced diet and/or a lack of exercise seem to be major contributors.

Research is on-going with the overriding aim to help explain why diabetes occurs at such high levels in the country. This will also help instigate preventative measures.

10. What are some of the serious effects of diabetes you are seeing in the UAE?

Diabetes brings with it serious complications related to the heart, eyes, blood vessels, kidneys, feet and nerves.

Some of the cases that we have witnessed in the UAE are:

Diabetic eye disease including diabetic retinopathy is a key cause of blindness, occurring as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately two per cent of people become blind, and about 10 per cent develop severe visual impairment.

Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50 per cent of people with diabetes. Although many different complications can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.

Diabetes is among the leading causes of kidney failure. Approximately 10-20 per cent of people with diabetes die from this complication.

Diabetes increases the risk of heart disease and stroke. People with type 2 diabetes are over twice as likely to have a heart attack or stroke as people who do not have diabetes.

Overall, the risk of premature death among people with diabetes is at least double the risk of those without diabetes. According to statistics, mortality linked to diabetes mellitus constitutes 75 per cent of the deaths among UAE nationals and 31 per cent among non-nationals

11. Is there much awareness of diabetes and how to prevent it amongst the UAE population?

Diabetes is now on the country’s top list of health concerns and is being tackled through awareness campaigns that focus on lifestyle changes. 

We believe that at governmental level the UAE is taking steps in the right direction by planning various nutrition and physical activity programmes in addition to driving public awareness campaigns.

Certainly, at Imperial College London Diabetes Centre we have contributed with a public health awareness campaign ‘Diabetes-Knowledge-Action’.

Launched in 2007 under the patronage of Her Highness Sheikha Fatima bint Mubarak, ‘Diabetes-Knowledge-Action’ is our multi-faceted public health awareness campaign.

‘Diabetes-Knowledge-Action’ is focused on disseminating knowledge surrounding diabetes prevention, symptoms and lifestyle support activities.

The campaign aims to inform the UAE community of the simple smart steps to maintain a healthy life, the risks of an unhealthy life, the complications that diabetes brings with it while making available the latest evidence-based treatments.

It aims to help prevent the number of diabetes patients through education and encourage testing for diabetes on a nationwide level so that people learn if they are affected or at risk.

The campaign’s main aim is to communicate how easy it is to maintain a healthy lifestyle by adopting a balanced diet and taking a 30-minute brisk walk each day.

The campaign presently has four pillars:

• Eat for Life invites children, parents and carers to consider what makes a balanced diet.

• Cook for Life looks to inspire families to cook healthy meals.

• Play for Life promotes regular exercise for healthy living to corporate teams.

• Walk for Life encourages the community to take at least a 30-minite brisk walk each day. Now in its seventh year, more than 17,000 people are expected to join in the nation’s leading annual Walk 2013 on November 15, to pace the five kilometre main walk around Abu Dhabi’s Yas Marina Circuit.