Diabetic patients should not end fast immediately if their blood sugar level falls below 60 mg.
Fast should also be broken if blood sugar is less than 70 mg per percentage in the first few hours after the start of the fast.
The risk associated with fasting is low in type 2 diabetes, which is well controlled with diet alone. But there is a potential risk of post meal high blood sugar if the patients overindulge in eating.
Type 2 diabetic patients on diet control who also follow a regular daily exercise program should modify their exercise program and not do it when they are fasting. They should exercise only after 2 to 3 hours of post sunset meal.
In diabetics with uncontrolled high blood sugar and high cholesterol, restriction of fluids intake during the day can precipitate dehydration leading to paralysis and heart attack.
Patients on met formin alone can fast as the possibility of low blood sugar is minimal. Two-third of the normal dose of met formin should be given immediately before post sunset meal and remaining one-third can be given in the morning if they take a fruit-based breakfast. Similarly patients on pioglitazone can fast without any change in the dosage pattern.
Diabetic patients who are on sulfonylurea drugs should talk to their doctors before fasting. Only glimepiride and gliclazide, which have also lower risk of low blood sugar can be given during fast but under medical supervision. Sometimes these drugs may be shifted to short-acting drugs like repaglinide during the period of the fast again under medical supervision.
Patients who are taking insulin and taking only one meal a day may have to adjust the dose of their insulin and the requirement of insulin may reduce up to 40%.
Most diabetic patients during fast will be controlled on a single dose of plain insulin before the major meal or longer-acting insulin at bed time.
Patients on plain insulin should talk to their doctor whether they need to shift to lispro insulin instead of regular insulin to reduce chances of low blood sugar.
Fasting diabetic patients who take heavy dinner may have to accordingly modify their insulin dose.
Simultaneously the dose of high blood pressure drugs may be reduced up to 40% during Navratri fasts.