Safe intermittent fasting possible for people with diabetes
Click Here to Manage Email Alerts
People with well-managed diabetes who wish to try intermittent fasting for weight loss or other reasons can do so safely with careful attention to glucose levels, particularly with continuous glucose monitoring, according to two speakers.
“During the COVID-19 pandemic, many of my patients [with diabetes] have told me they were having difficulty being home with so much access to their kitchen and food,” Joy Pape, MSN, RN, FNP-C, CDCES, WOCN, CFCN, FADCES, a family nurse practitioner at Weill Cornell Medicine’s Comprehensive Weight Control Center, told Healio. “Many have been stress eating, some from morning until night. For those who can safely practice intermittent fasting, I have recommended this, and for most it has been very helpful for their glucose levels and/or for their weight — at least by shortening the amount of time they are eating, which has been helpful to decrease carbohydrates and calories. I think it has also enhanced their awareness.”
Reasons for fasting
Findings from a recent survey conducted by DiabetesSisters, a national nonprofit organization for women living with diabetes, revealed a variety of reasons why people with diabetes might practice intermittent fasting, according to Anna Norton, MS, the organization’s CEO. Among the 265 U.S. residents with diabetes who said they practice intermittent fasting, 90% were women, 36% had type 1 diabetes, 56% had type 2 diabetes and 8% had prediabetes or another type of diabetes; 73% used insulin. Most said they fasted to manage their weight (59%) or to lower glucose levels (55%), whereas 49% said they fast “to feel better,” 20% cited religious observance and 12% reported that the reason was not related to diabetes.
Respondents also reported different fasting strategies, such as fasting for 13 hours, 16 hours, 18 hours or 24 hours at a time and doing so weekly (45%), monthly (13%) or another timeframe (42%), including fasting for blood work, Norton said during a presentation.
Fasting safely
“There are no overall guidelines for people who practice intermittent fasting in diabetes. This treatment is very individualized,” Pape said during a presentation.
Potential risks of intermittent fasting for someone with diabetes include hypoglycemia, hyperglycemia, diabetic ketoacidosis and dehydration, according to Pape.
“Someone has who has type 1 diabetes is in a higher-risk category, even though their time in range is within target,” Pape said. “Somebody with type 2 or prediabetes whose numbers are in target range may not be in a high-risk category.”
Risk can be assessed by considering recent diabetes history and potential effects of medications, such as hypoglycemia with insulin or sulfonylureas, DKA with SGLT2 inhibitors, or dehydration with antihypertensive drugs. Changing medications may help to reduce risks, Pape said.
“Patients who have diabetes should use CGM,” Pape said. “But for those who do not, I recommend checking a finger stick at least every 4 hours, also when they have symptoms and after treatment, for lows or for highs.”
Pape also recommends setting alerts for blood glucose levels below 80 mg/dL and above 200 mg/dL and always having some form of glucose available as well as noncarbohydrate beverages.
“Be aware of and teach about feasting, not just fasting,” Pape said. “And remember, it's not against the law to stop a fast.”
Collapse
Norton N, et al. Intermittent Fasting in The Management of Diabetes. Presented at: Association of Diabetes Care & Education Specialists Annual Meeting; Aug. 13-16, 2020 (virtual meeting).
Read more about
Click Here to Manage Email Alerts