Beyond the feeling of hunger and natural weakness, prolonged fasting may affect the management of a number of health conditions, including diabetes. People with diabetes can have different physical responses to fasting during Yom Kippur, depending on the type of diabetes and how it is usually managed (e.g., with insulin, other medications such as metformin or diet).
The most common complications are hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis (when the body burns fat for energy instead of glucose, resulting in the accumulation of dangerous chemicals in the blood) and dehydration and thrombosis. (Avoiding water and other fluids can cause dehydration; this can increase the risk of blood clots and strokes).
In some cases, the safest choice is not to fast (e.g., type 1 diabetics and women with gestational diabetes). However, some diabetics can reduce the risk of problems during Yom Kippur by making small changes to their diabetes management routine.
Some steps you need to take to get through the fast safely:
Consult your doctor
Although fasting is an important part of Yom Kippur, it is important to prioritize health. People are exempt from fasting if it endangers their health. Consult your doctor before beginning the fast to discuss the fasting plan and possible risks. You can also use online medical services and avoid exposure in the clinic these days.
Be sure to be fluid
During the fast, you will be limited to a small sip at a time. For the average person, this is about 30 grams. Avoid drinking caffeinated beverages before fasting and drink plenty of water before sunset on the eve of fasting.
Check your sugar levels
Maintain a routine of treatment and be sure to check your blood glucose level. Checking the sugar level will not break a fast and it is very important to monitor during it, you can also use a continuous sugar meter without punctures. Beware of hypoglycemia, nothing if your sugar levels drop too low, treat it by taking glucose or glucogel tablets, and / or other appropriate medical treatment.
Even during fasting it is possible to swallow drugs in the form of a tablet, capsule or liquid. Continue to take your medications, including insulin, as needed during the fast. Talk to your doctor before Yom Kippur to discuss the appropriate dosage and how you may need to change your medication during the fast.
Preparing for fasting
- The day before the fast, it is recommended to eat complex and simple carbohydrates every three hours: bread, pasta, fruit, etc. in order to replenish the glycogen supply in your body.
- Drink plenty of water, at least 2.3 liters.
The meal before the fast
- It is best to incorporate complex carbohydrates into the menu, as they are digested slowly, providing a feeling of satiety over time. Choose whole wheat bread, whole pasta, sweet potatoes, etc.
- It is recommended to add foods rich in protein and fats, which contribute to a feeling of satiety.
- It is best to give up spicy and salty foods, which cause thirst, as well as fried foods.
- It is best to avoid legumes and vegetables like broccoli, radishes and cauliflower.
- It is best to avoid carbonated beverages.
Conduct during the fast
- Measure your blood sugar levels frequently or use a continuous glucose meter to prevent extreme movement in your blood sugar levels.
- Drink a sweet and carb drink at all times.
- Change the medication as directed by your doctor, the day before the fast and during the fast itself. Usually long.term basal insulin should be significantly reduced, to 40.60% of the usual dose).
- In cases of hypoglycemia one should stop fasting and eat and drink as usual. This is when the blood sugar level reaches about 80 mg / dL.
- In case of a prolonged rise in blood sugar, one should stop fasting and drink plenty of water. Take insulin to avoid dehydration or acidosis.
Break the fast safely
Many people break the fast with high.carb foods. People with diabetes need to be very careful about their first meal. Prefer protein and vegetables rather than carbohydrates to prevent hyperglycemia. As always, check your blood sugar before and after eating and dose your medication properly.
- Break the fast with a drink at room temperature and even something as light as a slice of bread with a tablespoon of jam.
- About an hour later, it is recommended to eat a regular meal, for example – bread, cheese, tuna, eggs, salad, or chicken soup, etc.
- It is important to drink in moderation but still recover the fluids lost during the day.
- Remember – there is no need to make up for all the meals you did not eat during the day. On the contrary, too much food, especially carbohydrates, can interfere with sugar levels and cause a bad feeling.
Diabetes is a chronic disease in which the body does not produce the hormone insulin or use it properly, which leads to an increase in blood glucose levels that can damage various organs and tissues over time. Today, there are about half a million diabetics living in Israel and another half a million pre.diabetics.
There are two types of diabetes. Type 1 diabetes occurs when the pancreas does not produce insulin at all and type 2 diabetes occurs when the pancreas does not produce enough insulin, or the insulin does not work effectively. Gestational diabetes can occur during pregnancy, and usually passes after the baby is born.
Fasting is easy, healthy and safe.
* Professor Julio Weinstein is the director of the diabetes unit at Wolfson Medical Center