Fasts, feasts and festivals in diabetes-1: Glycemic management during Hindu fasts

Abstract

This communication is the first of a series on South Asian fasts, festivals, and diabetes, designed to spread awareness and stimulate research on this aspect of diabetes and metabolic care. It describes the various fasts observed as part of Hindu religion and offers a classification scheme for them, labeling them as infrequent and frequent. The infrequent fasts are further sub-classified as brief and prolonged, to facilitate a scientific approach to glycemic management during these fasts. Pre-fast counseling, non-pharmacological therapy, pharmacological modification, and post-fast debriefing are discussed in detail. All available drug classes and molecules are covered in this article, which provides guidance about necessary changes in dosage and timing of administration. While in no way exhaustive, the brief review offers a basic framework which diabetes care professionals can use to counsel and manage persons in their care who wish to observe various Hindu fasts.

Pragmatic dietary advice for diabetes during Navratris

“…[78] Abstinence of water and fluids during hot weather can result in dehydration, electrolyte imbalance, and hypotension while hyperglycemia can lead to loss of body fluids and electrolytes through excessive urination. [2]…”

“…Many types of fasts are observed by Hindus for cultural and religious issues such as annual KarvaChauth, Guru Purnima, Ahoi Ashtami, and Navratris. [2]…”

Glycemic management during Jain fasts

“…Jain fasts can last from 1 day to more than a month. [123] This review builds upon an earlier publication which has focused on the glycemic management of feasts, fasts, and festivals, as observed in the Hindu religion. [1]…”

“…[14] This should include the potential discomforts and risks of fasting, and means of mitigating them. The person's exact perspective of fasting, including duration of fast, allowance for liquids and snacks during the day, and acceptance of sublingual foods and freedom to break the fast in case of significant discomfort must be clarified.…”

Fasting practices in Tamil Nadu and their importance for patients with diabetes

“…[10] The Diwali – The “festival of lights” is celebrated in Tamil Nadu a day before the rest of the country (naraka chaturdashi). The Diwali day is marked by feasting of sweets and savories prepared from roasted bengal gram flour, rice flour, jaggery, sugar, ghee, and coconut.…”