As we enter the month of Ramadan, it is useful to remember the effects of fasting on diabetic patients.
Diabetes, or diabetes as it is popularly known, has been determined by the United Nations as a primary health problem that needs to be combated all over the world, and the World Health Organization has determined the disease as a new epidemic disease.
The prevalence of diabetes in our country is above the world average. Including 2 million 400 thousand latent diabetics, a total of 5 million people have diabetes or are under the threat of diabetes. According to the Turkey diabetes epidemiology study, the rate of diabetes in people over the age of 20 is 7.2% and 32% of these patients are not aware that they have diabetes.
Diabetes is a condition that develops as a result of the body's inability to obtain energy from blood sugar and causes the pancreas gland, which secretes the insulin hormone, to fail (Type II diabetes). In type I diabetes, the body cannot produce insulin since childhood due to immune deficiency.
In these patients, due to the effect of high blood sugar, disorders begin in organs, especially the kidneys, eyes and nerves. Of the patients diagnosed with type 2 diabetes, 20-30 percent have eye disorders, 10-20 percent have kidney disorders, 30-40 percent have hypertension, 50-80 percent have blood fat disorders and 80-90 percent have moderate diabetes. Complications of large-scale vascular damage occur. In addition, psychological and social problems follow due to the difficulty in accepting the disease.
In the early stages of diabetes, frequent and balanced nutrition controls the ups and downs in blood sugar and thus insulin secretion. is sufficient to cover it. When the disease progresses and medication use becomes necessary, nutrition remains equally important.
As it is known, skipping meals, staying hungry for long periods of time, or even eating less than necessary can cause "hypoglycemia" by dropping blood sugar excessively. Approximately 1/3 of diabetic patients fast despite doctors' warnings, and a significant portion of them consume more sweets during Ramadan for traditional reasons and due to excessive low blood sugar. People with new diabetes and especially those treated with pills Since most patients have not yet encountered the severe side effects of diabetes and are not sufficiently conscious, they do not see any harm in breaking the rules...
So, how does hunger and thirst for more than 10 hours affect diabetic patients? Among fasting patients, the rate of hypoglycemia (excessive low blood sugar) attack was found in 47% of patients using insulin. Hypoglycemia is a dangerous condition that causes symptoms such as sweating, tremors, dizziness, palpitations, numbness in the lips and hands, headache, lack of attention, fatigue, feeling of hunger, blurred vision, distraction, restlessness and irritability.
In addition, in patients with hyperthyroidism and using insulin, hypoglycemia attacks double when fasting.
At an international meeting held in Morocco in 1995, while controlled fasting with an acceptable risk was allowed in patients with type II diabetes, those who should not fast were reported as follows: Patients with type I diabetes, patients with irregular blood sugar, as well as patients with degenerative diseases. those with a disease, pregnant women and the elderly. In addition, education and monitoring should be continued carefully.
As a result, patients with diabetes must be under the supervision of a doctor if they fast. In addition, healthy individuals who have not yet been diagnosed with diabetes should have their postprandial blood sugar measured, as well as their fasting blood sugar, before they start fasting.
Let's also look at the effects of sugar on the eyes:
Irregular rises and falls in blood sugar negatively affect organs. The most important organ it affects in the eye is the RETINA (the layer of vision cells of the eye). The disease in the retina begins as punctate hemorrhages and micro-bubbles on the vascular walls and continues with vascular occlusions, leaks, neovascularization, sudden intraocular hemorrhages and tears. We know that this disease appears in the retina in 80-90% of diabetic patients within 10 years at the latest. If we remember how prevalent diabetes is in our country, we will understand the risk of vision loss. Diabetes, which is the leading cause of blindness in the world, is one of the leading diseases that threaten vision in our country.
For this reason, it is of great importance for patients diagnosed with diabetes to have retinal examinations every 6 months - 1 year, even if they have no complaints. It is impossible for the patient to detect this disease early, which begins as punctate disorders. However, these are seen during retinal examination. When diabetes-related retinal disease (diabetic retinopathy) is observed, angiography (medicated film of the eye vessels) is performed to determine whether laser treatment is required and, if so, how many sessions should be performed. Today, argon laser treatment is a method used all over the world. In addition, vision loss can be prevented by administering new drugs that reduce intraocular edema and vascularization in patients with fluid accumulation in the visual center due to vascular disorders in diabetes. Patients with retinopathy should continue to be monitored every 3 months after treatment ends. Because diabetes continues and this means that there will be new disorders in healthy parts of the eye. In summary, diabetic retinopathy is a disease that can end in permanent blindness if continuous monitoring and treatment is not performed and if treatment is delayed. In cases where it is too late, attempts are made to save the eye with vitreo-retinal surgery.
Cataracts and eye pressure are more common in diabetic patients than in other people. Just as the increase in blood sugar causes cataracts, fluctuations in blood sugar can temporarily impair the patient's vision. Therefore, when giving glasses to diabetic patients, care should be taken to ensure that the sugar level is at normal levels. High sugar increases the curvature of the eye, causing it to shift into myopia. There should be no rush for cataract surgery; the patient should be well informed that retinopathy progresses rapidly after cataract surgery and therefore retinal checks are even more important. The majority of these patients experience a short period of clear vision after cataract removal. When their vision decreases as a result of the progression of retinopathy, they apply to other centers in desperation, thinking that they have had an unsuccessful surgery.
Increased sugar also causes itching in the eyes. These can be relieved with simple eye drops. As it is known, there are no symptoms such as itching, watering etc. in retinal diseases.
Eye pressure (glaucoma) It is also important in diabetic patients. These patients also have problems such as blood pressure and cholesterol, and the blood pressure medications they use impair the nutrition of the optic nerve, even if the eye pressure does not increase much, making the patient more susceptible to vision loss due to glaucoma (normal tension glaucoma).
It is known that retinopathy due to diabetes progresses faster during pregnancy due to hormonal reasons. For this reason, retinal examination should be repeated frequently in these patients.
Diabetics, especially patients using insulin, should stay away from sugar or sweets during the holidays. Even people who do not have health problems should not consume too much sugar or dessert. Sugar causes aging in the body. Sugar has an inflammation-increasing effect in the body. This means a non-microbial inflammation. It threatens many organs in the body, especially the eyes, kidneys and nerves, and paves the way for degenerative diseases. If diabetic patients consume sweets or sugar during the holidays, they may experience problems such as dizziness, mental confusion, palpitations, fatigue, and blurred vision in a short time as a result of a sudden rise and subsequent drop in blood sugar (hypoglycemia).
To prevent this situation, let's ignore the sweets and candies we love so much, even if it's a holiday, and offer fruits that are not too sweet to our friends who we know have diabetes. Diabetics should also stay away from artificial sweeteners and ready-made foods. Hidden sugars, found under different names in a wide variety of ready-made food items, also pose a danger to diabetics.
The more consciously diabetic patients act about nutrition and lifestyle, the longer they can live a quality life. Even if it means giving up the tastes we love so much.
If we can learn to live with diabetes, we can make room for better pursuits in our lives.
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