Diabetics should be educated about clinical features of Hypoglycemia-Zaman Sheikh


Ramadan & Health Conference by JSMU and SSIDE-IV

Diabetics should be educated about clinical
features of Hypoglycemia - Zaman Sheikh

They should be advised to have increased fluid intake between Iftar and Sehar

We need evidence based studies to determine effects of maternal fasting,
more research on placenta and collaborative studies
between Muslim countries - Nazli Hossain

KARACHI: On September 10th third day of the Ramadan and Health Conference organized by JSMU and SSIDE Qazi Khalid Ali along with Prof. Iqbal Dean of Dental College at JSMU chaired the first session. Prof. Zaman Sheikh Director SSIDE was the first speaker who talked about Diabetes and Ramadan. He pointed out that hypoglycemia or hyperglycemia could lead to DKA which is a common emergency. Dehydration could also lead to serious complications and the reasons include less fluid intake by the patient, labour, exercise besides prolonged fasting time in some countries. He emphasized the importance of educating the patients about the clinical features of hypoglycemia and regular blood glucose monitoring should be carried during fasting. These patients should also be advised to have increased fluid intake between Iftar and Sehar, avoid food rich in fats, take Sehri as late as possible and avoid taking too much Dates.

Photographed during the Ramadan and Health conference organized by JSMU on September 10th from
(L to R) are Prof. Iqbal, Prof. Adel El Syed from Egypt, Prof. Ghulam Ashgar Channa VC SMBBMU,

Mr. Shaukat Ali Jawaid, Prof. Zaman Sheikh, Dr. Shabeen Naz Masood and Waqar Kashif.

The patients should be educated to break their Fast if their blood glucose is less than sixty and less than seventy in the morning. Similarly if blood sugar is more than 380, they should be advised to break Fast. They should also be counselled to avoid fasting during their sickness. With blood glucose control and life style modifications, these patients can Fast safely. As regards exercise, they can do it two hours after Iftar. Offering Taraweeh prayers, Prof. Zaman Sheikh said was a good exercise. Some insulin’s are safer during fasting and the patients need to modify the dose after discussion with his/her treating physician. Diabetics should be advised to have regular blood glucose monitoring daily. In addition they should avoid anger, jealousy, no fighting and no use of harsh words. Fasting offers numerous advantages as one can avoid metabolic syndrome, hypertension and obesity, he added.

Prof. Nazli Hossain from Dow University of Health Sciences spoke about perceptions and practices of pregnant women during Ramadan. She shared the results of various studies which looked at mother and fetus, maternal and fetal health in pregnant mothers. They all had concerns about maternal and fetal health. Some felt that mothers should not Fast if they are lactating, nursing. They often asked about effects of fasting on maternal and fetal health. Fasting does not lead to pre-term birth but the babies are low birth weight. Fasting has positive effect on TGs. Our study showed that there were no difference in metabolic properties during fasting. One can do fetal Biometry or Doppler ultrasound to see if the fetus is growing.  Fasting did lead to less weight of the baby as placental weight decreased during fasting. She was of the view that we need evidence based studies to determine effects of maternal fasting, more research on placenta and collaborative studies between Muslim countries.

Prof. Mansoor Ahmad a noted cardiologist was the next speaker who discussed Guidance for cardiac patients during Ramadan. He pointed out that cardiac patients can face life threatening problems during fasting due to disturbed sleep, drug regimen, timing while drug compliance was extremely important. There is not big difference as regards risk factors during fasting except cholesterol and TGs goes down, HDL goes up but overall risk factors do not improve. Almost 85-91% of stable cardiac patients can fast safely. Stable Congestive Heart Failure patients can also fast. Those patients who are on anti-coagulants, they must consult their physician a month before Ramadan. Those patients who are on high dose of diuretics should not fast. Similarly those patients who had recent hospitalization due to CHF should not fast. His advice was not to under estimate Heart Failure which is the most malignant of all cardiac diseases. Those patient who need multiple doses of drugs should also avoid fasting. Those patients who have undergone CABG or Angioplasty, stenting should not fast at least for one year and those who have uncontrolled hypertension  should also not fast, he added.

Prof. Nazeer Khan spoke about Effects of Fasting on Hypertensives and Diabetics. Giving results from different studies they had conducted he said that fasting leads to reduction in weight and BMI. It also leads to blood pressure reduction and blood glucose reduction while TGs are also reduced. He concluded his presentation by stating that fasting has positive effect in hypertension and diabetes mellitus.

The next session was chaired by Prof. Ghulam Ashgar Channa Vice Chancellor SMBBMU  along with Mr.Shaukat Ali Jawaid Chief Editor Pulse International and Pakistan Journal of Medical Sciences and Prof. Abuzar Wajidi. Prof. Shabeen Naz Masood from Isra University was the first speaker whose presentation was on “Is it safe to fast during pregnancy”. She opined that we must know how to counsel our patients. Fasting is practiced in different religions and almost three fourth of pregnant women do fast. Those having postpartum bleeding and menstrual bleeding should not fast. Those who are seriously ill should also avoid fasting. Pregnant women’s concerns are limited to fears about their health and their children. Pregnant women can break fast when she realizes that either she will die or it will harm the baby. Dehydration may lead to premature uterine contractions. One of her studies showed that seventy two pregnant women did not consult doctor during Ramadan, 92% were not aware of its importance while 8.5% feared that they won’t be allowed to fast. Only 5% patients did consult the doctor for advice during pregnancy about fasting. These pregnant women needs to be advised to break Fast in case of hypoglycemia.

Dr. Waqar Kashif discussed management of Chronic Kidney Disease during Ramadan.

Mr.Shaukat Ali Jawaid in his remarks pointed out that despite the fact that our healthcare professionals are very competent, but they are poor in documentation. Since they have no data, they cannot write papers. It is also disturbing to note that none of the journals published by Medical Universities and medical colleges enjoys an Impact Factor which is one of the yardstick to judge the quality and standard of a journal. This needs to be looked into by the concerned authorities. He also invited the attention of those present towards lack of reporting Adverse Drug Reactions by doctors in Pakistan. Efforts by CPSP and the Federal Health Ministry to establish an ADR Center have failed since no one is willing to report it as they do not wish to annoy the pharma companies who take care of them. However, it does compromise patient safety which is very serious. He gave a few examples how various drugs and drug combinations were withdrawn from the market once their serious fatal adverse effects were noted and highlighted by the medical press. His final advice to the healthcare professionals was to practice rational prescribing. If the patients can afford, they can prescribe expensive brands but if the patients are non-affording, they should prescribe economically priced molecules and numerous national pharmaceutical companies have marketed extremely safe, effective drugs at affordable prices for which we should be grateful to them.

Prof. Ghulam Ashgar Channa in his concluding remarks said that we need to involve religious scholars, educate them and through them pass on the message among the masses about the advantages of proper medical care during fasting. We need to develop a website which should have all the information related to fasting and different diseases, guidelines on safe fasting and it can be regularly updated. He also highlighted the importance of patient safety and ensuring patient satisfaction. Gone are the days when patients used to trust doctors as now they are much more educated and want to be involved in decision making regarding their disease. If you fail,   you may have to face litigation. He pointed out that some years ago Stappler device was introduced for management of hemorrhoids but we noticed serious complications, hence later its use was stopped. Healthcare professionals need to discuss these ADRs and share their knowledge with the colleagues to ensure patient safety, he added.

In the next session Dr. Maheen talked about Ramadan and diabetic survey in which they looked at the Knowledge, Attitude and Practice of the patients. Out of 2814 patients who were enrolled in the study, 1527 were male and 80% thought that visit to doctor during Ramadan was not necessary. Most of them were suffering from Type 2 diabetes and were on oral drugs. They study showed lack of awareness among the diabetics about how to manage diabetes during Ramadan. Ms. Erum from BIDE talked about the Helpline they had established for the diabetic patients offering round the clock service. The registered patients were contact on every third day and advice given regarding their dose adjustment of insulin. Fasting for Type 2 diabetics, she said, was safe provided they are provided education.