Treatment Of Diabetes During The Ramadan Fasting Time - Essay Example

Strategies for the treatment of diabetes during the Ramadan fasting time TABLE OF CONTENTS CHAPTER ONE: AIM AND OBJECTIVES REASONS FOR THE CHOICE OF THE TOPIC CHAPTER TWO LITERATURE REVIEW CHAPTER THREE: LIMITATIONS OF RESEARCH BIBLIOGRAPHY CHAPTER ONE AIM AND OBJECTIVES Current study examines the methods that can be used for the treatment of diabetes during the Ramadan fasting time. Regarding this issue several other themes – related with the specific subject - are going to be presented and evaluated. Under these terms, this paper is going to extensively refer to its main subject – as stated above – presenting at the same time the main aspects and the particular characteristics of a series of issues, which could be summarized to the following ones: a) What is diabetes and which are its main types? b) which are the most known – and the most developed – methods for the treatment of diabetes, c) is there any relationship between the development of diabetes and the nutrition habits of the population, d) the nutrition followed during fasting periods, especially the Ramadan, has been proved to have any impact on the progress of the treatment of diabetes and if yes, which are the main aspects of this impact? e) is the medical staff prepared and trained appropriately in order to handle effectively the treatment of diabetes? A special reference to the competence of medical staff to adapt the diabetes’ treatment to the nutrition ‘ethics’ of the Ramadan fasting period is going to be made at this point, f) which are the prospects for the development of diabetes’ treatment during the Ramadan fasting period (reference to experiments made in the relevant field). REASONS FOR THE CHOICE OF THE TOPIC The particular topic has been chosen because the issue under examination is particularly important for a significant part of the population. More specifically, in all populations around the world that follow the Ramadan fasting, the treatment of diabetes and its development through the fasting period has been a challenging task. Of course in many cases, alternatives are being proposed, however, it seems that the issue has not been explored appropriately and the studies and the experiments made in the area have to be ‘connected’ in order to lead to a secure assumption regarding the following two questions: a) which is the progress that has been made until now for the treatment of diabetes during the Ramadan fasting time and b) which are the prospects for the development of this treatment in the future. For this reason, current study is expected to help towards the appropriate presentation of the issue under examination providing all the theoretical and empirical research related with the specific field. CHAPTER TWO LITERATURE REVIEW Diabetes is a disease extremely extended in modern era. Its treatment has been an issue under examination mostly because there are several issues involved, like the effectiveness of the proposed measures to every person and most important, the chances for possible implications for the patient. The examination of the particular subject will be based on the theoretical views as they have been presented in the area of medical research combined with a series of experiments made by researchers in the particular field. Diabetes is a quite severe disease which has two types. The treatment used for its type is slightly differentiated. In general, both types have common elements of treatment, however type 1 diabetes seems to be rather severe and for this reason its treatment is ‘harder’ for the patient involved. In this context, it has been stated that ‘lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control’ (Diabetes, 2007). For this reason, the treatment used for this type of diabetes has to include ‘a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections’ (Diabetes, 2007). On the other hand, type 2 diabetes is easier to be ‘handled’. One of the main characteristics of type II diabetes is the existence of “abnormal sugar levels in the blood and failure of the pancreas to produce enough insulin to control the blood sugar” (EnerChi Health Inc, 2001). Moreover, because this type of diabetes is less ‘severe’ than the type 1, the relevant therapy involves practically in a healthy way of life while the provision of medical support is limited. More specifically, the treatment for this type of diabetes usually includes ‘diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin; approximately 40% of people with type 2 diabetes require insulin injections’ (Diabetes, 2007). Regarding the particular type of diabetes it is suggested that “any strategy one incorporates into his diabetes program requires constant monitoring of blood sugars and good communication with his physician as to what complementary or alternative practices he is considering” (EnerChi Health Inc, 2001). This means that this type of diabetes is in fact a disease that requires by the patient a healthy style of life and relevant nutrition habits. It should be noticed that this type of diabetes present a trend for increase the last years, perhaps because the changes in the nutrition habits and the lifestyle in general have cause severe ‘turbulences’ in the human body which by its turn requires the return to healthier living standards. Towards this direction, it has been stated by Cornell et al. (2004, 51) that “considering the dramatic increase in diabetes and the inability to reduce the morbidity and mortality associated with it, conventional treatment strategies need to be reevaluated; the focus of treatment in the management of type 2 diabetes needs to be on “fixing the problem” as opposed to treating the symptoms”. The specific reference to type II diabetes is made because of the expansion that the specific type of diabetes presents the last decade among people of all ages including children. The treatment of diabetes has been proved to be in the medical practice a challenging task. There are many methods proposed for its limitation; however there is no case of the disease’s elimination (disappearance) as the results of the experiments made in the relevant area have proved. A significant issue regarding the treatment of diabetes is the knowledge and the practice experience of the people involved in the relevant procedure (doctors and other medical staff). In this context, Rubin et al. (2007) made a research in order to “assess and compare the diabetes knowledge of nurses and residents in surgery, internal medicine, and family practice”. In accordance with the results of this study internal medicine residents (IMR), family practice residents (FPR) and inpatient registered nurses (RN) have been found to have “similar but insufficient levels of knowledge about diabetes” while the surgery residents (SR) were proved to have “a more profound deficit of diabetes knowledge”. The general conclusion of the above study was that “most nurses and residents require additional education in order to provide optimal care to patients with diabetes” (Rubin et al., 2007, 17). The above research can lead to the assumption that the inappropriateness of the measures often proposed for the limitation of the effects of type 2 diabetes is not the only reason for the inadequate handling of the disease’s limitation; the lack of appropriate training of the people participated in the treatment of the above disease seems to be the most important reason for the failures observed in the relevant procedure. The relationship of diabetes with the diet followed during the fasting period has been examined by Ramos et al. (2007). The above researchers tried to examine the influence of specific medication (of glyburide and insulin) on the treatment of Gestational diabetes mellitus (GDM) in women “who had OGCT >/=200 mg/dl and fasting hyperglycemia”. Towards this direction, they proceeded to the examination of a series of cases of women treated with the above medication between the years 1999 and 2002. It has been noticed by the researchers that “exclusion criteria included pretreatment fasting >/=140 mg/dl, gestational age >/=34 weeks and multiple gestation while maternal and neonatal outcomes were assessed” (Ramos et al., 2007). The above research proved that “in women with GDM who had a markedly elevated OGCT and fasting hyperglycemia, glyburide achieved similar birth weights and delivery outcomes but was associated with an increased risk of macrosomia” (Ramos et al., 2007). The effectiveness of medication provided to the patients in the above case should be considered as a significant finding regarding the treatment of this type of diabetes. However, the relevant issue could be possibly explored more extensively in order to cover a greater area of similar cases even those suffering from different type diabetes. From another point of view, the study of Sachon et al. (2006) revealed that “there is no data today directly proving that post-prandial glycaemia is specifically related to the development of micro and macrovascular complications; the patients must be required to monitor their post-prandial glycaemia 2 hours after the beginning of the meal only when the aim is to lower the HbA1c below 7% or 6.5%, for example during pregnancy, or in case of discrepancy between glycaemia at 8 a.m. and 7 p.m. (below 1.20 g/)l and HbA1c (above 7%); in other cases, in type 2 diabetes, two glycaemias per day, fasting and vesperal, seems sufficient” (Sachon et al., 2006, 377). The above study is of particular importance for the patients that suffer from the specific type of diabetes and follow the Ramadan fasting. More specifically, following the methods presented in the above research, patients can possibly control the development of diabetes without alternating their nutrition ethics as these have to be formulated in accordance with the rules of the Ramadan fasting. The above findings are in accordance with those revealed in the study of Cornell et al. (2004, 51) who came to the conclusion that “patients who monitor their blood glucose levels frequently and on a regular basis often have better control over their diabetes; if patients test their blood glucose prior to and 2 hours after a meal, they can observe the effect that a specific amount of food has on their blood glucose levels; molecules are allowed to enter into the cell from the bloodstream, resulting in improved glucose uptake and improved insulin sensitivity”. However, even if followed strictly, the above guidelines cannot guarantee the success of the treatment which needs to be based on the application of a series of methods as provided by the medical supervisor in a particular case. Regarding the therapy of type I diabetes it has been found through the stydy made by Herbst et al. (2007) that “patients with type 1 diabetes require continuous substitution of exogenous insulin due to their disability to produce insulin themselves; the insulin dosage required is individual-specific and may change dramatically during the perioperative period; the patient may be endangered by metabolic decompensation including hypoglycaemia and diabetic ketoacidosis; thus, perioperative management should include frequent blood glucose measurements and frequent adjustment of the insulin and glucose administration”. The presentation of the therapy suggested for type 1 diabetes has been made in order to evaluate its effectiveness in cases of people that follow the Ramadan fasting. Under these terms, the continuous measurement of blood glucose required in the treatment of type 1 diabetes should not be considered at a first level as a particularly ‘negative’ issue regarding the adoption of the nutrition program included in the Ramadan fasting. However, because there is continuously the risk of hypoglycaemia, the people suffered by this type of diabetes should try to adapt their nutrition needs (as defined by the nutrition regime imposed in the particular treatment) to their fasting program in order to avoid any severe damage or even death. On the other hand, it should be noticed that in order to formulate an appropriate nutrition program for a person that suffer from diabetes, it is necessary that all the particular elements of this person’s health condition are analyzed and evaluated in order to avoid any possible negative outcome of the treatment suggested. Regarding this issue, it has been supported by Franz et al. (2002, 148) that “historically, nutrition principles and recommendations for diabetes and related complications have been based on scientific evidence and diabetes knowledge when available and, when evidence was not available, on clinical experience and expert consensus; often it has been difficult to discern the level of evidence used to construct the nutrition principles and recommendations while in clinical practice, many nutrition recommendations that have no scientific supporting evidence have been and are still being given to individuals with diabetes”. The above findings lead to the assumption that the treatment offered to people with diabetes is often inappropriate while the medical staff ‘engaged’ in the particular activity does not have the necessary knowledge required for the planning and the monitoring of the relevant treatment. These assumptions are also in accordance with those of Rubin et al. (2007) presented above regarding the level of training provided to the medical staff involved in the treatment of diabetes. The influence of fasting in the development of diabetes seems to be still unclear. More specifically, the study of Franz et al. (2002, 150 showed that “a number of factors influence glycemic response to food, including the amount of carbohydrate, type of sugar (glucose, fructose, sucrose, lactose), nature of the starch (amylose, amylopectin, resistant starch), cooking and food processing (degree of starch gelatinization, particle size, cellular form), and food structure; fasting and preprandial glucose concentrations, the severity of glucose intolerance, and the second meal or lente effect are other factors affecting the glycemic response to food”. In other words, fasting has been proved to affect the glycemic response to food intervening ‘indirectly’ to the development of diabetes. However, because this interaction has not measured with accuracy any assumption regarding the level of influence of fasting on the development of diabetes would be just hypothetical. As of the role of medical staff involving in the relevant procedure it has been found that “using at least two quality improvement strategies provides a greater chance for success in controlling patient blood sugar levels than does using a single quality improvement strategy; providers who use a combination of two or more quality improvement strategies are more likely to conform to the highest standard of care in the treatment of patients with diabetes than are providers who rely on a single QI strategy” (Agency for Healthcare Research and Quality, 2004). In this context, the medical staff that participates in a particular program for the treatment of diabetes has to be appropriately prepared (training, experience) trying to protect patients from any possible risk related with this treatment. Of course there is always the chance of the unexpected outcome due to the intervention of factors that are out of control (failure of patient to inform the medical staff on a specific health problem co-existed with the diabetes or denial to follow the treatment as suggested by the medical practitioner or even alternate it without his permission and so on). It is necessary that in a severe disease like diabetes all guidelines given by the medical practitioners are followed strictly avoiding proceeding to initiatives that can lead to unexpected outcomes. In order to assess the development of diabetes during the Ramadan, we should refer to the main characteristics of this fasting period at least referring to the issues that are related with the nutrition. In this context, it has to be noticed that – among other obligations – during Ramadan a person has to avoid eating “from sunrise to sunset” [1]. After the sunset “a large meal, often with extra savoury and sweet foods is eaten” [1]. At this point, eating the food of ‘a day’ in one meal could be regarded at a first stage as an extremely risky practice especially for people suffering from diabetes. However, regarding specifically this part of population it has been proved that “a) there is an overall improvement in glycaemic control during the fast, b) significant hypoglycaemia is unlikely on similar average doses of oral hypoglycaemic agents before and during Ramadan” [1]. In other words, Ramadan has been proved to have a proactive role towards the success of the treatment for diabetes. However, a more thorough examination of the particular issues related with the effects of fasting on the treatment of diabetes could be useful towards the improvement of this treatment and possible the application of its principles to patients that do not follow particular programs in their nutrition. CHAPTER THREE: LIMITATIONS OF RESEARCH Current research has to be structured in accordance with the availability of data related with the subject under examination. More specifically, while the part of population that suffers from diabetes is quite extended, in fact the study needs to be focused on the treatment strategies followed (or suggested to) by the people who follow the Ramadan fasting. The gathering of data in this case has to refer to specific part of the population and involve in the provision of personal data, i.e. effectiveness or possible adverse outcomes of treatment strategies related with the diabetes. Under these terms, the use of surveys or interviews could be considered as rather pointless. The provision of personal data related with health problems is a very difficult decision and for this reason the responsiveness should – in advance – be regarded as limited. For these reasons current research has to be based on the experiments and the general medical research made in this area trying to provide all useful suggestions as they have been stated by the medical researchers in the particular field. BIBLIOGRAPHY Abdillah, A., Abdel-Kader, Kamel, al-Athari, T. (1996) Ramadan and Fasting, available at http://www.qss.org/articles/ramadan/toc.html Agency for Healthcare Research and Quality (2004) Closing the quality gap: A critical analysis of diabetes care strategies, available at www.ahrq.gov Cornell, S., Briggs, A. (2004). Newer Treatment Strategies for the Management of Type 2 Diabetes Mellitus. Journal of Pharmacy Practice, 17(1): 49-54 Diabetes (2007), available at http://www.diabetesdigest.com/dd_basics4.htm EnerChi Health Inc (2001) Diabetes, available at http://www.enerchihealth.com/medical/diabetes.html Franz, M., Bantle, J., Beebe, C., Brunzell, J., Chiasson, J., Garg, A., Holzmeister, L., Hoodere, B., Mayer, E., Mooradian, A., Purnell, J., Wheeler, M. (2002) Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications. Diabetes Care, 25(1): 148-192 Herbst, A., Kiess, W. (2007) Type 1 diabetes mellitus: Perioperative management of children and adolescents. Anaesthesist, Mar. 16 Ramadan – implications for patients with type 2 diabetes www.gpnotebook.co.uk [1] Ramos, G., Jacobson, G., Kirby, R., Ching, J., Field, D. (2007) ‘Comparison of glyburide and insulin for the management of gestational diabetics with markedly elevated oral glucose challenge test and fasting hyperglycemia. Journal of Perinatology, Mar. 15 Rubin, D., Moshang, J., Jabbour, S. (2007) Diabetes knowledge: are resident physicians and nurses adequately prepared to manage diabetes? Endocrine Practice, 13(1): 17-21 Read More