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India is a land of festivals. The period between October and January is full of festivities. For people with certain health conditions, particularly those living with diabetes, this is a highly testing time. India is currently termed the diabetic capital of the world with more than 70 million people living with this condition. It is important for people living with diabetes to focus on their treatment and management goals during the festive season too.

Que: What are the hazards to the patient with diabetes during the festival season?

The festival season includes periods of fasting and feasting. Many patients with diabetes fast for varying periods during this period.

One of the serious consequences of fasting is hypoglycaemia (very low blood sugar which occurs if the sugar level is less than 70 mg/dl). This can be potentially fatal and can have long term consequences and should be avoided at all costs.

The symptoms of hypoglycaemia include sweating, shaking, hunger, dizziness, palpitations and in extreme cases confusion, drowsiness and unconsciousness.

If the patient is conscious then he/she should immediately consume 15 grams of glucose or sugar followed by some snacks like fruits, biscuits, sandwiches. Fingerpick glucose check 15 minutes after taking the sugar should ideally be done to see if the blood sugar has risen to at least 90mg/dL or more and if not, the sugar intake has to repeated. If the patient is unable to take by mouth because of drowsiness or unconsciousness then he must immediately be taken to the nearest hospital.

On most occasions high blood sugar does not have immediate symptoms. Typically, very high blood sugar symptoms include excessive thirst, frequent urination, blurry vision, fatigue, dry mouth.

Que: Should patients with diabetes fast during festivals?

Ideally patients with diabetes should not fast. None of the religions mandate fasting for people who have illness. However, should anyone have a strong desire to fast then he must discuss this with his diabetes doctor. Some anti diabetes medications carry a low risk of hypoglycaemia and hence in such cases the diabetes doctor may make temporary changes to the medications to include those with the lowest risk of hypoglycaemia. However, patients on insulin and sulphonylurea group of drugs remain at a higher risk of hypoglycaemia during fasting.

Que: Do we need to change the diabetes medications during the festival season?

Discussing the medications with the diabetes doctor before the festivities will always help in reducing the swings of blood sugar during festivals. If needed your doctor may make minor adjustments to your medications. Particularly those on insulin will definitely benefit from pre festival advice. On some occasions your doctor may advice extra rapid acting insulin on days where more than usual amount of food is consumed. It is of vital importance that medications must be taken on time and the food should be taken as close to the usual routine of the patient as possible.

Que: Should patients with diabetes have sweet products during festivals?

There has to be balance as far as food consumption is concerned. If occasionally a sweet is taken then for that particular meal the amount of carbohydrate (rice, roti) should be reduced so that there is less rise of blood sugar. “Cold drinks” cause significant elevations of blood sugar and hence should be replaced with low sugar drinks like diet coke/diet pepsi. Sugar free products in moderation may be taken and one of the sugar free agents called sucralose is also heat resistant and may be added to hot drinks.

Que: What food should a patient with diabetes choose during festivities?

Carbohydrates are the type of food which in higher quantities causes blood sugar to go up. High carbohydrate containing food includes sweets, chow mien, noodles, pizza, idli, and high amounts of rice, roti, paratha. So, the trick is to take less food with high carbohydrate content. Instead more amounts of vegetables (any vegetables, few pieces of potato are allowed), dal, fish can be taken. Taking more amounts of salad and boiled vegetables before a meal gives a feeling of fullness leading to less consumption of high carbohydrate and fried food. This may not be applicable for patients with kidney disease. It is a good idea to reduce the portion size and include a variety of food groups. Any two fruits a day is allowed for patients with diabetes and hence fruit based desserts rather than sugar based desserts should be encouraged. Walking after a meal also helps burn up the extra calories. The exertion during the festivities may cause dehydration and hence it is important to consume adequate water to prevent dehydration. Alcohol, if consumed, should only be taken in moderation (not more than two “standard pegs in 24 hours) and should not be taken in an empty stomach as it may lead to hypoglycaemia (very low blood sugar) after a few hours.

There is no reason that a person with diabetes cannot enjoy the festivities during the festival season. Actually, nowadays the term “Diabetes diet” has been replaced by the term “Healthy diet”. Hence the above advice is just as applicable to the common population without diabetes. It is important however to keep a regular check on the blood sugar levels for peole with diabetes. So, best wishes for all the upcoming festivals !!

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