How to manage diabetes during festivals

During the festival season, which spans from October to January in India, the vibrant celebrations can pose a significant challenge for individuals with certain health conditions, especially those living with diabetes. It is crucial for people with diabetes to remain focused on their treatment and management goals throughout this festive period. In view of the concerns around chronic diseases like diabetes, Dr. Kalyan Kumar Gangopadhyay, consultant, Endocrinology at CMRI, Kolkata advises on managing blood sugar amidst festive feasting and fasting.

The festival season entails a mix of fasting and feasting. Many individuals with diabetes choose to fast for varying durations during this time. Fasting can lead to a severe condition known as hypoglycemia, characterized by dangerously low blood sugar levels (below 70 mg/dl). Hypoglycemia can have severe consequences, including potential fatality and long-term effects, making it imperative to avoid at all costs. Symptoms of hypoglycemia include sweating, tremors, hunger, dizziness, palpitations, and, in severe cases, confusion, drowsiness, and unconsciousness. If the patient is conscious, they should promptly consume 15 grams of glucose or sugar, followed by snacks such as fruits, biscuits, or sandwiches. It's recommended to check blood glucose levels 15 minutes after sugar intake to ensure they have risen to at least 90mg/dL. If not, further sugar intake is necessary. In cases of unconsciousness or severe drowsiness, immediate hospitalization is essential.

In an ideal scenario, individuals with diabetes should avoid fasting, as no religion mandates fasting for those with medical conditions. However, if someone strongly desires to fast, they should consult their diabetes doctor. Some anti-diabetes medications carry a low risk of hypoglycemia, and in such cases, the doctor may temporarily adjust the medications to include those with the lowest risk of hypoglycemia. Nevertheless, patients on insulin and sulfonylurea drugs remain at a higher risk of hypoglycemia during fasting.
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Engaging in a discussion with your diabetes doctor before the festivities can help in stabilizing blood sugar levels during the festival season. Minor adjustments to medications may be necessary, especially for those on insulin. On some occasions, your doctor may recommend extra rapid-acting insulin on days with higher food consumption. Adhering to a regular medication schedule and maintaining a meal routine as close to the usual schedule as possible is of utmost importance.

Maintaining a balanced approach to food consumption is essential. If you occasionally indulge in sweets, reduce the consumption of carbohydrates (rice, roti) for that specific meal to minimize blood sugar spikes. Carbonated "cold drinks" can significantly raise blood sugar levels, so they should be replaced with low sugar "diet" drinks. Sugar-free products can be consumed in moderation, and sucralose, a heat-resistant sugar-free sweetener, can be added to hot drinks.

Carbohydrates are the primary food type that causes blood sugar to rise, so it's important to consume less high-carb foods. Instead, increase the intake of vegetables (excluding high-carb ones like potatoes), lentils, and fish. Including ample salad and boiled vegetables before a meal provides a sense of fullness, reducing the consumption of high-carb and fried foods. Reducing portion sizes and incorporating a variety of food groups is advisable. Patients with diabetes can enjoy up to two servings of fruit per day, making fruit-based desserts preferable to sugar-based ones. Post-meal walks aid in burning extra calories. The exertion during festivals may lead to dehydration, so it's crucial to stay adequately hydrated. If consuming alcohol, do so in moderation (not exceeding two "standard pegs" in 24 hours), and avoid drinking on an empty stomach to prevent hypoglycemia.

(Author: Dr. Kalyan Kumar Gangopadhyay, consultant, Endocrinology at CMRI, Kolkata)