MAKAN SECARA SIHAT BERPUASA DAN - Abbott Nutrition
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BERPUASA DAN MAKAN SECARA SIHAT DI BULAN RAMADAN & HARI RAYA TIP BERPUASA SEMASA BULAN RAMADAN UNTUK MEREKA YANG MENGHIDAP DIABETES Risalah ini dihasilkan untuk memberikan maklumat penting sebagai persiapan untuk anda berpuasa dengan selamat di bulan Ramadan. Rujuk doktor, dietitian atau pasukan pengurusan diabetes anda sebelum mengambil keputusan untuk berpuasa. Kandungan risalah ini bertujuan untuk makluman sahaja dan tidak bertujuan untuk menggantikan nasihat pengamal perubatan berdaftar. Maklumat ini tidak boleh digunakan untuk mendiagnosis masalah kesihatan atau mengubati diri sendiri. Untuk maklumat lanjut, sila rujuk pakar penjagaan kesihatan anda.
RAMADAN
ADALAH BULAN
PERUBAHAN DAN
MEMPERBAIKI DIRI
Ibadah berpuasa di bulan Ramadan adalah satu kewajipan bagi
semua umat Islam dewasa yang sihat, dan ia adalah salah satu
daripada lima rukun Islam.1,2 Selain ganjaran pahala, puasa di bulan
Ramadan juga memberi manfaat kesihatan secara fizikal termasuk
penurunan berat badan dan gula darah.2
Ramadan menawarkan peluang yang sempurna untuk
mengubah gaya hidup. Risalah ini berfungsi sebagai alat pendidikan
yang dihasilkan khas untuk mereka yang menghidap diabetes jenis 2
untuk membantu anda kekal sihat di bulan Ramadan
dan bulan-bulan seterusnya.
BERUBAHLAH KE ARAH YANG LEBIH BAIK DARI SEGI
ROHANI DAN FIZIKAL, PADA BULAN RAMADAN INI!
PERSIAPAN
SEBELUM
RAMADAN
Jika anda merancang untuk berpuasa, anda perlu berjumpa doktor dan
dietitian anda 6 hingga 8 minggu sebelum Ramadan untuk menjalani
semakan dan pendidikan perubatan pra-Ramadan.1 Semasa lawatan
ini, doktor anda boleh mendapatkan sejarah perubatan terperinci anda,
melakukan penilaian risiko, dan menasihati anda mengenai pelarasan dos
ubat-ubatan dan menentukan sama ada berpuasa adalah selamat untuk
anda.1 Dietitian boleh membantu anda melakukan pengubahsuaian diet
yang diperlukan untuk disesuaikan dengan puasa Ramadan.1,3
MANFAAT PENDIDIKAN PRA-RAMADAN UNTUK
MEREKA YANG MENGHIDAP DIABETES:1
Membantu anda memahami risiko berpuasa
dan mengetahui sama ada anda boleh
berpuasa dengan selamat
Membantu mengenali gejala-gejala komplikasi
ringan atau teruk apabila berpuasa
Mampu meminimumkan risiko komplikasi
melalui pelarasan ubat dan perancangan
menu hidangan makanan di bulan Ramadan
Boleh mengekalkan kawalan gula darah dan
mencegah kenaikan berat badan dengan
membuat perubahan gaya hidupMEMANTAU SENDIRI PARAS GULA
DARAH SEMASA BULAN RAMADAN
Mereka yang menghidap diabetes dan bercadang untuk berpuasa dinasihatkan untuk memantau
paras gula darah mereka secara teratur dan pada bila-bila masa apabila terdapat simptom-simptom
hipoglisemia (gula darah rendah), hiperglisemia (gula darah tinggi) atau berasa kurang sihat3,4
SIMPTOM
GULA DARAH RENDAH 1
GULA DARAH TINGGI1
(HIPOGLISEMIA) (HIPERGLISEMIA)
Berpeluh/ Status mental Peningkatan Kerap membuang
berasa seram berubah rasa dahaga air kecing
sejuk
Menggeletar Lapar
Jantung berasa Lapar Kekeliruan Kelesuan
berdebar-debar
(palpitasi)
BILA PERLU
BERBUKA PUASA?
Berbuka puasa dengan segera jika mana-mana daripada
keadaan ini berlaku ke atas anda:1,3,5
BACAAN GULA DARAH
3.3 mmol/L < 3.9 mmol/L > 16.7 mmol/L
pada bila-bila masa dalam beberapa jam
semasa berpuasa pertama berpuasa
• Mengalami simptom hipoglisemia atau hiperglisemia
• Simptom-simptom yang mencadangkan dehidrasi
(kekurangan air) yang teruk (contohnya pengsan
dan kekeliruan)PANDUAN HARIAN BULAN RAMADAN
UNTUK MEREKA YANG MENGHIDAP DIABETES
PEMAKANAN
Semasa sahur • Mengambil makanan karbohidrat yang dihadam dengan perlahan (seperti
gandum, kekacang dan beras) dengan jumlah protein dan lemak yang
mencukupi1,3,5
• Melambatkan waktu sahur, sejurus sebelum bermulanya tempoh berpuasa1,3
• Minum air secukupnya dan minuman tanpa gula untuk mengekalkan tahap
penghidratan yang mencukupi sepanjang hari anda1
Semasa iftar • Mulai iftar anda dengan minum banyak air (untuk mengatasi
(berbuka dehidrasi) dan ambil 1-2 biji kurma untuk meningkatkan paras gula
puasa) darah anda1,3
• Makan hidangan makanan utama anda selepas solat Maghrib3
• Ambil pencuci mulut yang sihat dalam saiz yang sederhana
(contohnya sepotong buah) dan elakkan mengambil pencuci mulut
yang tinggi kandungan gulanya1
Snek • Pilih snek yang lebih sihat (contohnya sepotong buah, segenggam kekacang
atau sayur-sayuran) untuk dimakan antara hidangan makanan1
• Formula khusus diabetes (FKD) juga boleh dimasukkan sebagai snek1
MEMANTAU SENDIRI PARAS GULA DARAH
• Periksa paras gula darah anda secara teratur, seperti sebelum sahur dan 2 jam selepas iftar3,4
UBAT-UBATAN
• Ambil ubat anda seperti yang dinasihatkan oleh doktor anda, semasa bersahur dan iftar4PANDUAN PEMAKANAN RAMADAN
(RAMADAN DIETARY GUIDE, RDG)
Diet pada bulan Ramadan untuk mereka yang menghidap diabetes seharusnya
tidak berbeza daripada diet yang sihat dan seimbang3,5
5 TIP UTAMA PANDUAN PEMAKANAN RAMADAN
1 2 3 4 5
Mengambil Termasuk Minum sekurang- Melewatkan Memasukkan
jumlah kalori karbohidrat kurangnya waktu formula khusus
harian yang berserat tinggi 8 gelas air atau bersahur1,3 diabetes (FKD)
mencukup*1 (rendah GI), protein, minuman tanpa dalam penyediaan
buah-buahan dan gula1,3 menu makanan
sayur-sayuran pada anda1
waktu sahur dan
iftar, dan elakkan
pengambilan
pencuci mulut yang
terlalu manis1,3
1 cawan 3 - 4 auns protein
sayur-sayuran tanpa lemak
1 potong kecil
2 gelas air buah contohnya
tembikai atau
2 biji kecil kurma
2 sudu
kecil minyak
1/3 cawan 1 - 1½ cawan
kekacang/lentil/kacang pea nasi bijian penuh
HIDANGAN RAMADAN YANG IDEAL1
*Sasaran kalori harian- 1,500 kcal: Untuk penyelenggaraan berat badan untuk wanita < 150 cm tinggi dan penurunan berat badan
untuk wanita > 150 cm tinggi; 1,800 kcal: Untuk penyelenggaraan berat badan untuk wanita > 150 cm tinggi dan penurunan berat
badan untuk lelaki.1
GI: indeks glisemik.
REBUTLAH PELUANG DI BULAN RAMADAN INI UNTUK
MEMBUDAYAKAN TABIAT MAKAN SEPANJANG HAYAT YANG SIHATFAHAMI TENTANG
FORMULA KHUSUS DIABETES (FKD)
FKD adalah pemakanan tambahan yang dirumus khusus untuk membantu
pengurusan diabetes dan menyediakan pemakanan seimbang di bulan
Ramadan untuk mereka yang menghidap diabetes6-8
Terapi pemakanan perubatan (yang terdiri daripada makanan rendah
kalori, penggantian hidangan makanan FKD dan aktiviti fizikal) telah
terbukti meningkatkan kawalan diabetes dan penurunan berat badan
yang lebih baik berbanding dengan diet biasa6,7
Karbohidrat yang dicerna dengan perlahan dalam FKD membantu
mewujudkan rasa kenyang dan meningkatkan rembesan glucagon
seperti peptida 1 (glucagon-like peptide-1, GLP-1) yang seterusnya
membantu kawalan gula yang lebih baik9,10
Menggabungkan Glucerna®; FKD No. 1 yang paling disyorkan
oleh pakar penjagaan kesihatan^, dalam hidangan menu
makanan anda di bulan Ramadan untuk membantu mengawal
pengambilan kalori anda dan mengekalkan paras gula darah
anda dalam kawalan7,10
x5 + =
5 scoops 200 ml
Kajian saintifik menunjukkan bahawa myo-inositol
cold/warm water11
membantu meningkatkan kepekaan insulin dan
membantu mengurus paras gula11-13
^Berdasarkan penjejakan HCP Abbott Serantau untuk Pemakanan Dewasa yang dilakukan
oleh IQVIA dari April hingga September 2019 di antara 191 profesional penjagaan kesihatan
di Semenanjung Malaysia; +Berbanding dengan versi Glucerna® sebelumnya.BAGAIMANA UNTUK MEMASUKKAN
GLUCERNA® SEBAGAI SEBAHAGIAN DARIPADA
PELAN HIDANGAN MENU MAKANAN RAMADAN SAYA?
Glucerna® boleh digunakan bagi menggantikan 1 atau 2 snek atau sebagai sebahagian daripada
hidangan sahur atau iftar anda. Anda juga boleh memasukkan Glucerna® ke dalam resipi pencuci
mulut yang sihat untuk masa snek anda.
CADANGAN PELAN MENU MAKANAN UNTUK
MEREKA YANG MENGHIDAP DIABETES*:14
SAHUR
• Roti bijian penuh: 2 keping/
• Salad/ulam: 1 cawan
nasi bijian penuh: 1 cawan
• Susu: 1 gelas, dengan 3 sudu
• Sayur kacang goreng
besar oat atau 6 sudu besar
dengan telur: 1 cawan
FKD (Glucerna®)
• Ikan sambal bakar:
• Air/minuman tanpa gula
1 saiz tapak tangan
IFTAR
• Sup rendah lemak dengan
• Kurma: 1–2 biji/buah: 1 daging tanpa lemak dan
potong kecil sayur-sayuran: 1.5 mangkuk
kecil
• Salad/ulam: 1 cawan; • Nasi (bijian penuh/beras
minyak zaitun: 1 sudu teh rebus basmati): 1.5 cawan
• Tempeh dengan ikan bilis:
• Air/minuman tanpa gula
1 cawan
• Ayam panggang tanpa
lemak: 1 saiz tapak
tangan
SNEK YANG SIHAT
• Susu: 1 gelas, dengan 3
sudu besar oat atau 6 • Kurma: 1–2 biji
sudu besar FKD (Glucerna®)
ATAU
• Karipap berinti ayam bakar:
• Air/minuman tanpa gula
1 biji/popiah basah: 1 biji
*Berdasarkan 1,800 kcal/sehari. sudu besar
(tablespoon, tbsp); sudu kecil (teaspoon,tsp);
FKD: formula khusus diabetes. • Air/minuman tanpa gulaLAKUKAN PERUBAHAN GAYA HIDUP
YANG KECIL SEMASA BULAN RAMADAN
Selain melakukan perubahan terhadap diet harian dan tabiat makan anda, adalah penting untuk
mengekalkan berat badan yang optimum, melakukan senaman secara berkala, mematuhi regimen
pengambilan ubat anda dan mendapatkan rehat yang baik untuk memastikan diabetes anda terkawal3,5
SENAMAN
• Senaman berintensiti ringan dan sederhana boleh dikekalkan1,3,5
• Lakukan senaman 2 jam selepas iftar1
• Elakkan aktiviti fizikal yang berlebihan kerana ia boleh meningkatkan
risiko hipoglisemia dan dehidrasi1,3,5
• Menunaikan solat Tarawih membantu mengekalkan aktiviti fizikal
anda1,3,5
PELARASAN
UBAT-UBATAN
• Sesetengah ubat diabetes memerlukan pelarasan dos atau masa
semasa berpuasa untuk mengurangkan risiko komplikasi1,3
• Berjumpa dengan doktor anda sebelum bulan Ramadan untuk
menjalani penilaian pra-Ramadan bagi membincangkan tentang
pelarasan ubat ini1
REHAT
• Cuba berehat buat seketika di siang hari jika anda berasa letih
semasa berpuasa15
• Dapatkan tidur yang mencukupi untuk menyegarkan diri semula
keesokan harinya tetapi jangan tidur lebih lama daripada biasa1,16ADAKAH PUASA SELAMAT UNTUK
WARGA TUA YANG MENGHIDAP DIABETES?
Berpuasa berpotensi meningkat risiko komplikasi kesihatan kepada pesakit diabetes yang lebih
tua seperti hipoglisemia dan hiperglisemia, adakalanya memerlukan kemasukan ke hospital1,17,18
BERIKUT ADALAH TIP UNTUK MEMBANTU WARGA TUA
BERPUASA DENGAN SELAMAT DI BULAN RAMADAN
Menjalani penilaian dan perbincangan dengan doktor anda
sebelum berpuasa untuk mengetahui tentang risiko komplikasi
anda dan pelarasan ubat1,19
Memastikan pengambilan nutrien yang mencukupi semasa iftar1,3
• Ikuti 5 petua utama Panduan Pemakanan Ramadan
• Jangan tinggalkan sahur dan lewatkan waktu bersahur
• Masukkan formula khusus diabetes (FKD) dalam menu hidangan
makanan sahur/iftar anda
Pantau rapi paras gula darah anda dan tingkatkan kekerapan
pemantauan gula1
Mengenali simptom-simptom hipoglisemia dan hiperglisemia,
dan berbuka puasa apabila ia tidak lagi selamat untuk anda
terus berpuasa1
Pastikan anda minum air secukupnya
semasa sahur dan iftar1
Mendapatkan rehat dan
tidur secukupnya19PENGURUSAN DIABETES DI HARI RAYA
@ SELEPAS BULAN RAMADAN
Semasa sambutan Hari Raya, terutamanya pada beberapa hari pertama, mungkin terdapat risiko
hiperglisemia kerana pengambilan kalori yang tinggi semasa berhariraya bersama keluarga dan
sahabat-handai20,21
10 TIP BERHARIRAYA @ SELEPAS BULAN RAMADAN
UNTUK MEREKA YANG MENGHIDAP DIABETES
Kawal saiz hidangan makanan
dan kurangkan pengambilan Pantau paras gula darah anda
makanan mengandungi lemak dan dengan lebih kerap20,22,23
gula yang tinggi20,22,23
Berjalan pantas atau bersenam
Makan makanan berkarbohidrat untuk menstabilkan gula darah23
yang diserap perlahan-lahan secara
relatif (contohnya nasi basmati atau
biryani), serta buah-buahan dan
sayur-sayuran, untuk mengekalkan Minum air secukupnya untuk
paras gula darah yang stabil22 mencegah dehidrasi23
Ubah resipi tradisional untuk
menjadikannya lebih sihat Berbincang dengan doktor
contohnya menggantikan gula anda untuk mendapatkan
dengan pemanis atau memilih nasihat mengenai pengurusan
tepung gandum penuh dan paras gula darah atau untuk
bukannya tepung putih22,23 berbincang mengenai pelarasan
regimen ubat selepas sebulan
berpuasa1,23
Pilih pencuci mulut yang lebih sihat
contohnya salad buah-buahan22 Masukkan FKD (Glucerna®)
untuk menggantikan hidangan
makanan anda sekurang-
kurangnya sekali sehari untuk
Kembali ke regimen ubat pra- membantu mengawal kalori dan
Ramadan biasa anda20 mencapai paras gula darah
yang optimum8GLUCERNA® BAHARU DENGAN FORMULA YANG
DIPERTINGKATKAN MEMBANTU DALAM PENGURUSAN
DIABETES DAN MENYEDIAKAN PEMAKANAN SEIMBANG
UNTUK PENGHIDAP DIABETES
x5 + =
5 scoops 200 ml
cold/warm water11
MENGGABUNGKAN GLUCERNA® SEBAGAI SEBAHAGIAN DARIPADA
PELAN MENU HIDANGAN RAMADAN ANDA UNTUK MEMBANTU
MENGAWAL DIABETES ANDA DI BULAN RAMADAN & HARI RAYA INI
*Glucerna telah ditunjukkan dapat mengurangkan turun naik paras gula darah, apabila digunakan sebagai pengganti sarapan sebagai sebahagin
daripada intervensi gaya hidup; ^Berdasarkan penjejakan HCP Abbott Serantau untuk Pemakanan Dewasa yang dilakukan oleh IQVIA dari April
hingga September 2019 di antara 191 profesional penjagaan kesihatan di Semenanjung Malaysia; +Berbanding dengan versi Glucerna® sebelumnya.
Rujukan
1. International Diabetes Federation and the DAR International Alliance. Diabetes and Ramadan: Practical guidelines, Brussels, Belgium: International
Diabetes Federation, 2021. Available at www.idf.org/guidelines/diabetes-in-ramadan. Accessed on 9 February 2021. 2. Meo SA, Hassan A.
Physiological changes during fasting in Ramadan. J Pak Med Assoc. 2015;65(5 Suppl 1):S6-14. 3. Ministry of Health. Practical guide to diabetes
management in Ramadan. Available at http://www.diabetesmalaysia.com.my/file_dir/330692495558cf6ea041da.pdf. Accessed on 15 January 2021.
4. Hassanein M, Al-Arouj M, Hamdy O, et al. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract. 2017;126:303-16. 5. Al-Arouj M,
Assaad-Khalil S, Buse J, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895-902.
6. Chee WSS, Gilcharan Singh HK, Hamdy O, et al. Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm
(tDNA) in individuals with type 2 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care. 2017;5(1):e000384. 7. Jáquez A, Sánchez
JJ, Acevedo N, Guzmán E (2020) Efficacy of diabetes-specific formulas as meal replacements in diabetic patients: an overview. Int J Endocrinol
Metab Disord. 2020;6(2):dx.doi.org/10.16966/2380-548X.168. 8. Mohd Yusof BN, Wan Zukiman WZHH, Abu Zaid Z, et al. Comparison of structured
nutrition therapy for Ramadan with standard care in type 2 diabetes patients. Nutrients 2020;12(3):813. 9. Lim GE, Brubaker PL. Glucagon-like peptide
1 secretion by the L-cell. The view from within. Diabetes 2006;55(Suppl 2):S70-7. 10. Devitt AA, Oliver JS, Hegazi RA, Mustad VA. Glycemia Targeted
Specialized Nutrition (GTSN) improves postprandial glycemia and GLP-1 with similar appetitive responses compared to a healthful whole food breakfast
in persons with type 2 diabetes: a randomized, controlled trial. Journal of Diabetes Research and Clinical Metabolism 2012,1:20. 11. Fraticelli F,
Celentano C, Zecca IA, et al. Effect of inositol stereoisomers at different dosages in gestational diabetes: an open-label, parallel, randomized controlled
trial. Acta Diabetol. 2018;55(8):805-12. 12. Guo X, Guo S, Miao Z, Li Z, Zhang H. Myo-inositol lowers the risk of developing gestational diabetic
mellitus in pregnancies: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. J Diabetes Complications.
2018;32(3):342-8. 13. Pintaudi B, Di Vieste G, Bonomo M. The effectiveness of myo-inositol and D-chiro inositol treatment in type 2 diabetes. Int J
Endocrinol. 2016;2016:9132052. 14. International Diabetes Federation and Diabetes and Ramadan International Alliance. Diabetes and Ramadan:
practical guidelines. 2016. Available at https://www.worlddiabetesfoundation.org/sites/default/files/IDF%20%26%20DAR%20Guidelines%20April-16-
low_0.pdf. Accessed on 15 January 2021. 15. Know Diabetes. Diabetes and Ramadan. Available at https://www.knowdiabetes.org.uk/be-healthier/
ramadan/. Accessed on 27 January 2021. 16. Wexner Medical Center. How diabetics can observe Ramadan and stay healthy. Available at https://
wexnermedical.osu.edu/blog/how-diabetics-can-observe-ramadan-and-stay-healthy. Accessed on 27 January 2021. 17. Azzoug S, Mahgoun S,
Chentli F. Diabetes mellitus and Ramadan in elderly patients. J Pak Med Assoc. 2015;65(5 Suppl 1):S33-6. 18. Hassanein M, Hussein Z, Shaltout I. The
DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes.
Diabetes Research and Clinical Practice 2021;doi:https://doi.org/10.1016/j.diabres.2021.108674. 19. Ahmed SH, Chowdhury TA, Hussain S. et al.
Ramadan and diabetes: a narrative review and practice update. Diabetes Ther. 2020;11:2477-520. 20. Akbani MF, Saleem M, Gadit WU, Ahmed M,
Basit A, Malik RA. Fasting and feasting safely during Ramadan in the patient with diabetes. Practical Diabetes Int. 2005;22(3):100-4. 21. Ibrahim M,
Davies MJ, Ahmad E, et al. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD
consensus. BMJ Open Diabetes Research and Care 2020;8:e001248. 22. Diabetes.org. July 2016: Plan your eid celebrations now, advises Diabetes
UK. Available at https://www.diabetes.org.uk/about_us/news/plan-your-eid-celebrations-now-advises-diabetes-uk. Accessed on 15 January 2021. 23.
Diabetes Queensland. Nine tips for a healthy Eid ul-Fitr. Available at https://www.diabetesqld.org.au/uncategorized/nine-tips-for-a-healthy-eid-ul-fitr/.
Accessed on 15 January 2020. 24. Peng J, Lu J, Ma X, et al. Breakfast replacement with a liquid formula improves glycaemic variability in patients with
type 2 diabetes: a randomised clinical trial. British Journal of Nutrition 2019;121(5):560-6.
Dapatkan sampel Glucerna® percuma sekarang!
Pesanan pendidikan ini dibawa kepada anda oleh:
Abbott Laboratories (M) Sdn Bhd (163560-X)
MAL.2021.13158.GLU.1 03/23
© 2021 Abbott Laboratories Sdn Bhd. Semua hak cipta terpelihara.FASTING AND EATING HEALTHILY DURING RAMADAN & RAYA TIPS FOR FASTING DURING RAMADAN FOR PEOPLE LIVING WITH DIABETES This booklet is designed to provide important information to prepare you for a safe fasting during Ramadan. Consult your doctor, dietitian or diabetes management team before deciding to fast. The information provided in this booklet is for information purposes only and is not intended to take the place of the advice of a registered medical practitioner. This information should not be used for diagnosing health problems or for self-medication. For further information, please consult your healthcare professionals.
RAMADAN
IS THE MONTH OF
CHANGE AND
IMPROVEMENT
Fasting during Ramadan is an obligation for all healthy adult
Muslims, and it is one of the five pillars of Islam.1,2 Besides
spiritual rewards, the Ramadan fast also provides physical health
benefits including reduction in body weight and blood sugar.2
Ramadan offers the perfect opportunity for a change of lifestyle.
This booklet serves as an educational tool specially designed
for people with type 2 diabetes to help you stay healthy during
Ramadan and throughout the proceeding months.
CHANGE FOR THE BETTER YOU, SPIRITUALLY
AND PHYSICALLY, THIS RAMADAN!PREPARATION
BEFORE
RAMADAN
If you are planning to fast, you should visit your doctor and
dietitian 6 to 8 weeks before Ramadan for a pre-Ramadan
medical review and education.1 During this visit, your doctor will
be able to obtain your detailed medical history, perform a risk
assessment, and advise you on medication dose adjustments and
whether fasting is safe for you or not.1 Dietitian can assist you to
make necessary dietary modifications to suit Ramadan fasting.1,3
BENEFITS OF PRE-RAMADAN EDUCATION
TO PEOPLE WITH DIABETES:1
Help you understand the risks of fasting and
find out if you can fast safely
Help to recognise the symptoms of mild or
more severe complications when fasting
Able to minimise the risk of complications
through medication adjustments and Ramadan
meal planning
Able to maintain blood sugar control and
prevent weight gain by making lifestyle
changesSELF-MONITORING BLOOD SUGAR
DURING RAMADAN
People with diabetes intending to fast are advised to monitor their blood sugar levels
regularly and at any time when there are symptoms of hypoglycaemia (low blood sugar),
hyperglycaemia (high blood sugar) or feeling unwell3,4
SYMPTOMS OF
LOW BLOOD SUGAR1 HIGH BLOOD SUGAR1
(HYPOGLYCAEMIA) (HYPERGLYCAEMIA)
Sweating/ Altered Extreme Frequent
chills mental status thirst urination
Trembling Hunger
Palpitations Hunger Confusion Fatigue
WHEN
TO END A FAST?
End your fast immediately if any of these conditions occur:1,3,5
BLOOD SUGAR
3.3 mmol/L < 3.9 mmol/L > 16.7 mmol/L
at any time in the first few
during the fast hours of fasting
• Experience symptoms of hypoglycaemia or
hyperglycaemia
• Symptoms suggestive of severe dehydration (e.g.
fainting and confusion)RAMADAN DAILY GUIDE
FOR PEOPLE WITH DIABETES
NUTRITION
During sahur • Consume slow-digesting carbohydrate foods (such as wheat,
beans and rice) with an adequate amount of protein and fat1,3,5
• Take sahur as late as possible, just before the start of the fast1,3
• Drink enough water and non-sweetened beverages to maintain
an adequate level of hydration throughout your day1
During iftar • Start your iftar with plenty of water (to overcome dehydration)
and 1-2 kurma (dates) to raise your blood sugar levels1,3
• Eat your main meal after Maghrib prayers3
• Consume a moderate amount of healthy dessert (e.g. a piece of
fruit) and avoid sugar-heavy desserts1
Snacks • Choose healthier snacks (for example one piece of fruit, a handful
of nuts or vegetables) to be consumed between meals1
• Diabetes-specific formula (DSF) can also be included as a snack1
SELF-MONITORING OF BLOOD SUGAR LEVEL
• Test your blood sugar level regularly, such as before sahur and 2 hours after iftar3,4
MEDICATIONS
• Take your medications as advised by your doctor, during sahur and iftar4RAMADAN DIETARY GUIDE (RDG)
The diet during Ramadan for people with diabetes should not differ from a healthy
and balanced diet3,5
5 KEY TIPS OF THE RAMADAN DIETARY GUIDE
1 2 3 4 5
Consume an Include high Drink at least Take sahur Include
adequate fibre (low GI) 8 glasses of as late as diabetes-specific
amount of total carbohydrates, water or possible1,3 formula (DSF)
daily calories*1 proteins, fruits non-sweetened into your meals1
and vegetables beverages1,3
at both sahur
and iftar,
and avoid
sugar-heavy
desserts1,3
1 cup 3 - 4 oz
vegetables lean protein
2 glasses
of water 1 small slice of fruit
e.g. watermelon or
1-2 kurma
2 tsp oil
1/3 cup 1 - 1½ cups
beans/lentils/peas whole grain rice
IDEAL RAMADAN PLATE1
*Target daily calories- 1,500 kcal: For weight maintenance for women < 150 cm tall and weight reduction for women > 150 cm tall;
1,800 kcal: For weight maintenance for women > 150 cm tall and weight reduction for men.1
GI: glycaemic index.
GRAB THE OPPORTUNITY DURING RAMADAN TO
CULTIVATE LIFE-LONG HABITS OF EATING HEALTHILYUNDERSTANDING
DIABETES-SPECIFIC FORMULA (DSF)
DSF is a nutrition supplement specifically formulated to support
diabetes management and provide balanced nutrition during
Ramadan for people with diabetes6-8
Medical nutrition therapy (consisting of the low-calorie meal, DSF
meal replacement and physical activity) has been shown to improve
diabetes control and weight loss better than standard diets6,7
Slowly digestible carbohydrates in DSF help promote satiety and
increase secretion of glucagon-like peptide-1 (GLP-1) which in
turn support better sugar control9,10
Incorporate Glucerna®; the No. 1 most recommended DSF
by healthcare experts^, in your meals during Ramadan to help
control your calorie intake and keep your blood sugar
level in check7,10
x5 + =
5 scoops 200 ml
Scientific studies have shown
cold/warm water11 that myo-inositol
helps to improve insulin sensitivity, leading to
better sugar control11-13
^Based on Abbott Regional HCP Tracking for Adult Nutrition conducted by IQVIA
from April to September 2019 among 191 healthcare professionals in Peninsular Malaysia;
+
Compared to previous version of Glucerna®.HOW TO INCLUDE GLUCERNA®
AS PART OF MY RAMADAN MEAL PLAN?
Glucerna® can be used in place of 1 or 2 snacks or as part of your sahur or iftar meal.
You can also include Glucerna® into healthy dessert recipes for snack time.
THE SUGGESTION OF A MEAL PLAN FOR PEOPLE WITH DIABETES*:14
SAHUR
• Wholegrain bread:
• Salads/ulam: 1 cup 2 slices/wholegrain rice:
1 cup
• Milk: 1 glass, with 3 tbsp
• Stir-fried beans with egg:
of oats or 6 tbsp of DSF
1 cup
(Glucerna®)
• Baked sambal fish:
• Water/unsweetened drinks
1 palm size
IFTAR
• Low-fat soup with lean meat
• Kurma: 1–2 /fruit:
and vegetables:
1 small slice
1.5 small bowls
• Rice (wholegrain/
• Salads/ulam: 1 cup;
parboiled basmati):
olive oil: 1 tsp
1.5 cups
• Tempeh with anchovies: • Water/unsweetened
1 cup drinks
• Lean grilled chicken:
1 palm size
HEALTHY SNACK
• Milk: 1 glass, with 3 tbsp
of oats or 6 tbsp of DSF • Kurma: 1–2
(Glucerna®)
OR • Baked chicken curry puff:
• Water/unsweetened
1 piece /popiah basah:
drinks
1 piece
*Based on 1,800 kcal/day.
tbsp: tablespoon; tsp: teaspoon; • Water/unsweetened
DSF: diabetes-specific formula. drinksMAKING SMALL LIFESTYLE CHANGES
DURING RAMADAN
Besides making changes to your daily diet and eating habits, it is essential to maintain
an optimal weight, perform regular exercise, follow your medication regimen and get a
good rest to keep your diabetes in control3,5
EXERCISE
• Light and moderate intensity exercise may be maintained1,3,5
• Perform exercise 2 hours after iftar1
• Avoid excessive physical activity as it may increase the risk
of hypoglycaemia and dehydration1,3,5
• Performing the Tarawih prayer helps maintain your physical
activity1,3,5
MEDICATIONS
ADJUSTMENT • Some diabetes medications will require dose or timing
adjustments during fasting to minimise the risk of
complications1,3
• Visit your doctor before Ramadan for a pre-Ramadan
assessment to discuss about this1
REST
• Try to rest at some point in the day if you feel tired while
fasting15
• Get plenty of sleep to recharge for the next day but do not
sleep for longer than usual1,16IS FASTING SAFE FOR THE
ELDERLY WITH DIABETES?
Fasting can put older patients with diabetes at an increased risk of health complications
such as hypoglycaemia and hyperglycaemia, at times requiring hospitalisation1,17,18
HERE ARE THE TOP TIPS TO HELP ELDERLY PEOPLE
FAST SAFELY DURING RAMADAN
Have an assessment and discussion with your doctor
prior to fasting to learn about your complication risk
and medication adjustment1,19
Have an adequate intake of nutrients during iftar1,3
• Follow the 5 key tips of Ramadan Dietary Guide
• Do not skip sahur and take it as late as possible
• Include diabetes-specific formula (DSF) in your sahur/iftar meals
Pay close attention to your blood sugar levels and
increase the frequency of sugar monitoring1
Look out for symptoms of hypoglycaemia and hyperglycaemia,
and end your fast when it is unsafe to continue1
Drink enough water during sahur and iftar1
Get enough rest and sleep19MANAGING DIABETES DURING RAYA
@ POST-RAMADAN
During Raya, especially during the first few days, there can be risks of hyperglycaemia
due to high consumptions of calories while feasting with family and friends20,21
10 RAYA @ POST-RAMADAN TIPS
FOR PEOPLE WITH DIABETES
Practice portion control and Monitor your blood sugar
minimise intake of foods that levels more regularly20,22,23
are high in fats and sugar20,22,23
Brisk-walk or exercise to
Eat foods that are absorbed
stabilise your blood sugar23
relatively slowly (e.g. basmati
rice or biryani), as well as fruits
and vegetables, to keep a Drink enough water to
stable blood sugar level22 prevent dehydration23
Make changes to traditional
Talk to your doctor for advice
recipes to make them healthier
about the management of
e.g. replace sugar with
blood sugar levels or to
sweetener or opt for whole
discuss medication regimen
wheat flour instead of white
readjustments after a month
flour22,23
of fasting1,23
Choose healthier desserts
Include DSF (Glucerna®) to
e.g. fruit salads22
replace your meal at least
once a day to help control
Return to your usual pre- the calories and to achieve
Ramadan medication regimen20 optimal blood sugar level8
DSF: diabetes-specific formula.NEW GLUCERNA® WITH IMPROVED FORMULA SUPPORTS
DIABETES MANAGEMENT AND PROVIDES A BALANCED
NUTRITION FOR PEOPLE WITH DIABETES
x5 + =
5 scoops 200 ml
cold/warm water11
INCORPORATE GLUCERNA® AS PART OF YOUR RAMADAN MEAL PLAN
TO SUPPORT YOUR DIABETES CONTROL THIS RAMADAN & RAYA
*Glucerna has been shown to reduce glucose fluctuations, when used as a breakfast replacement as part of a lifestyle intervention; ^Based on Abbott
Regional HCP Tracking for Adult Nutrition conducted by IQVIA from April to September 2019 among 191 healthcare professionals in Peninsular
Malaysia; +Compared to previous version of Glucerna®.
References
1. International Diabetes Federation and the DAR International Alliance. Diabetes and Ramadan: Practical guidelines, Brussels, Belgium: International
Diabetes Federation, 2021. Available at www.idf.org/guidelines/diabetes-in-ramadan. Accessed on 9 February 2021. 2. Meo SA, Hassan A.
Physiological changes during fasting in Ramadan. J Pak Med Assoc. 2015;65(5 Suppl 1):S6-14. 3. Ministry of Health. Practical guide to diabetes
management in Ramadan. Available at http://www.diabetesmalaysia.com.my/file_dir/330692495558cf6ea041da.pdf. Accessed on 15 January 2021.
4. Hassanein M, Al-Arouj M, Hamdy O, et al. Diabetes and Ramadan: Practical guidelines. Diabetes Res Clin Pract. 2017;126:303-16. 5. Al-Arouj M,
Assaad-Khalil S, Buse J, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895-902.
6. Chee WSS, Gilcharan Singh HK, Hamdy O, et al. Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm
(tDNA) in individuals with type 2 diabetes: a randomized controlled trial. BMJ Open Diabetes Res Care. 2017;5(1):e000384. 7. Jáquez A, Sánchez
JJ, Acevedo N, Guzmán E (2020) Efficacy of diabetes-specific formulas as meal replacements in diabetic patients: an overview. Int J Endocrinol
Metab Disord. 2020;6(2):dx.doi.org/10.16966/2380-548X.168. 8. Mohd Yusof BN, Wan Zukiman WZHH, Abu Zaid Z, et al. Comparison of structured
nutrition therapy for Ramadan with standard care in type 2 diabetes patients. Nutrients 2020;12(3):813. 9. Lim GE, Brubaker PL. Glucagon-like peptide
1 secretion by the L-cell. The view from within. Diabetes 2006;55(Suppl 2):S70-7. 10. Devitt AA, Oliver JS, Hegazi RA, Mustad VA. Glycemia Targeted
Specialized Nutrition (GTSN) improves postprandial glycemia and GLP-1 with similar appetitive responses compared to a healthful whole food breakfast
in persons with type 2 diabetes: a randomized, controlled trial. Journal of Diabetes Research and Clinical Metabolism 2012,1:20. 11. Fraticelli F,
Celentano C, Zecca IA, et al. Effect of inositol stereoisomers at different dosages in gestational diabetes: an open-label, parallel, randomized controlled
trial. Acta Diabetol. 2018;55(8):805-12. 12. Guo X, Guo S, Miao Z, Li Z, Zhang H. Myo-inositol lowers the risk of developing gestational diabetic
mellitus in pregnancies: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. J Diabetes Complications.
2018;32(3):342-8. 13. Pintaudi B, Di Vieste G, Bonomo M. The effectiveness of myo-inositol and D-chiro inositol treatment in type 2 diabetes. Int J
Endocrinol. 2016;2016:9132052. 14. International Diabetes Federation and Diabetes and Ramadan International Alliance. Diabetes and Ramadan:
practical guidelines. 2016. Available at https://www.worlddiabetesfoundation.org/sites/default/files/IDF%20%26%20DAR%20Guidelines%20April-16-
low_0.pdf. Accessed on 15 January 2021. 15. Know Diabetes. Diabetes and Ramadan. Available at https://www.knowdiabetes.org.uk/be-healthier/
ramadan/. Accessed on 27 January 2021. 16. Wexner Medical Center. How diabetics can observe Ramadan and stay healthy. Available at https://
wexnermedical.osu.edu/blog/how-diabetics-can-observe-ramadan-and-stay-healthy. Accessed on 27 January 2021. 17. Azzoug S, Mahgoun S,
Chentli F. Diabetes mellitus and Ramadan in elderly patients. J Pak Med Assoc. 2015;65(5 Suppl 1):S33-6. 18. Hassanein M, Hussein Z, Shaltout I. The
DAR 2020 Global survey: Ramadan fasting during COVID 19 pandemic and the impact of older age on fasting among adults with Type 2 diabetes.
Diabetes Research and Clinical Practice 2021;doi:https://doi.org/10.1016/j.diabres.2021.108674. 19. Ahmed SH, Chowdhury TA, Hussain S. et al.
Ramadan and diabetes: a narrative review and practice update. Diabetes Ther. 2020;11:2477-520. 20. Akbani MF, Saleem M, Gadit WU, Ahmed M,
Basit A, Malik RA. Fasting and feasting safely during Ramadan in the patient with diabetes. Practical Diabetes Int. 2005;22(3):100-4. 21. Ibrahim M,
Davies MJ, Ahmad E, et al. Recommendations for management of diabetes during Ramadan: update 2020, applying the principles of the ADA/EASD
consensus. BMJ Open Diabetes Research and Care 2020;8:e001248. 22. Diabetes.org. July 2016: Plan your eid celebrations now, advises Diabetes UK.
Available at https://www.diabetes.org.uk/about_us/news/plan-your-eid-celebrations-now-advises-diabetes-uk. Accessed on 15 January 2021.
23. Diabetes Queensland. Nine tips for a healthy Eid ul-Fitr. Available at https://www.diabetesqld.org.au/uncategorized/nine-tips-for-a-healthy-eid-ul-
fitr/. Accessed on 15 January 2020. 24. Peng J, Lu J, Ma X, et al. Breakfast replacement with a liquid formula improves glycaemic variability in patients
with type 2 diabetes: a randomised clinical trial. British Journal of Nutrition 2019;121(5):560-6.
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