With the Islamic fasting month of Ramadan about to start, almost 17 percent of Egyptians suffering from diabetes face a dilemma: Should they fast?

Ahram Online spoke to Dr Fawzi El-Shubaki, professor of nutrition at the National Research Institute, and Dr Mohamed Thabet, consultant of endocrinology, about key points that diabetics should ponder when considering whether or not to abstain from food and drink from dawn till dusk during this year's Ramadan.

Egypt ranks ninth country worldwide with the most cases of diabetes, a condition caused by a patient's insufficient production of insulin or inability to use it properly to regulate blood sugar levels, and is expected to be the eighth in the world by the year 2030.

The number of diabetics in the Middle East tends to increase faster that in other regions, with respective increase rates of 83 and about 50 percent, according to the International Diabetes Federation.

Lifestyle is surely a factor, Dr Abbas Orabi, professor at Zagazig University, told Ahram Online, but genetics may also be partly responsible for the region's relatively high increase rate for the illness.

Understand the risks

There are two types of diabetes.

Type 1 develops in childhood or adolescence, and is the result of the pancreas not secreting any or enough insulin, which puts the patient at a great risk of experiencing a drop in blood sugar levels. Insulin injections are usually necessary for survival.

Type 2, more common, usually develops in adults, and is linked to their bodies' ineffective use of insulin. This type of diabetes involves a lower risk of a drop in blood sugar level. The treatment is usually tablet-based, with a minimal need for insulin.

But a drop in blood sugar during fasting hours is not the only risk facing a diabetic.

After breaking a fast, overindulgence in food and sweets can cause the opposite: an increase in blood sugar levels.

Dehydration is also a risk, which is why a minimum of nine cups of water or unsweetened beverages should be consumed between Iftar, when Muslims break their day's fast, and Sohour, the last meal of the night before resuming fasting the next day.

Alter your medication plan

Before the beginning of Ramadan, ask your physician if fasting is safe. Never take it for granted that you can fast because you have during previous years.

In general, if approved by the doctor, insulin-treated patients should regulate their intake of the treatment to include long-acting insulin at Sohour, and short-acting insulin at Iftar.

Those whose treatments include Metormin should divide the daily dosage as follows: a third at Suhour, and two thirds at Iftar.

For those whose treatments include the Sitagliptin, Pioglitazone, or Vildagliptin, the dosage should be administered only at Iftar.

It should be noted that all above recommendations vary according to each patient and must be followed only on the instructions of a physician.

Set limits to feasting

In Ramadan, Egyptians often view each meal as a feast, which could be a problem.

Foods and beverages that are low on the glycemic index are vital meal components during Ramadan. These give you the impression of being full and contain sugars that take a longer time for the body to digest.

Examples are:

• Brown bread, whole grains and rice
• Beans (fuul)
• Apples, pears and oranges
• Skimmed dairy products
• Lean sources of protein like fish and chicken

Drink a lot, and avoid too much caffeine, as it can cause dehydration.

Dates are a staple food in Ramadan, but too many can be harmful due to their high sugar content.

Be alert

The following signs could indicate a drop in blood sugar:

• Headaches
• Tremors
• Palpitations
• Drowsiness

Always have a glucose meter within reach to check your blood sugar levels at regular intervals while fasting.

Fasting should be ended immediately if your sugar levels fall below 70 mg/dl.