Introduction:

Intermittent fasting is a very helpful strategy in controlling elevated blood sugar in diabetics. Diabetes is a chronic metabolic disease that exhibits abnormally elevated blood sugar associated with intrinsically abnormal lipid metabolism and elevated biochemical markers which can cause life threatening acute and chronic complications in the body if not treated properly.

Intermittent fasting is one of the several steps undertaken in order to decrease the blood sugar and cholesterol levels back to normal values and to avoid acute and chronic complications to set in.

Other steps employed in controlling the blood sugar in diabetic patients are regular exercise, medical nutrition therapy, low calorie diet, taking of insulin injections and oral maintenance medications for diabetes.

During the CoviD19 pandemic,people are restricted to go out from their respective abode and stopped their daily exercise regimen such as jogging, running, brisk walking  and work-outs in the gym, and most of them stayed long watching infront of the television entertained by netflix movies accompanied by increase consumption of short-ordered high calorie food delivered directly from the fast food chains.

Thus with sedentary lifestyle and increase calorie intake can result to obesity and increase weight gains associated with elevated blood sugar and cholesterol levels in some diabetic patients.

Then sedentary lifestyle and obesity will further add new cases of prediabetes and diabetes to the existing number of population with diabetes.

 

Likewise many of the patients with diabetes accompanied with other comorbidities failed to take some of their maintainance oral medications, because no oral medications are available due to pill shortages or others failed to buy or avail the oral medications due to strict locale lockdowns.

It is very important that blood sugar levels in people with diabetes shoud be in normal range especially in these unprecendented times of the Covid19 pandemic.

Since people with comorbidities such as diabetes, hypertension, chronic obstructive pulmonary disease and chronic kidney disease are prone or easily gets infected with the novel coronavirus and tend to progress in severe and critical illness or Acute Respiratory Distress Syndrome(ARDS).

Patient with CoviD19 disease in critical condition in the Intensive care unit.

Regimen and Strategies To Control Blood Sugar In Diabetics:

 


Oral antidiabetes medications.

So one of the strategy and technique applied aside from taking insulin, oral anti-diabetes medications and regular exercise to lower or control blood sugar levels is intermittent fasting. Intermittent fasting is defined as timed-restricted feeding,a strategy develop by many apparently healthy common/laypress people and become a fad or a common trend and advertisements in the social medias, the purpose is for weight loss and decrease body fats and its application in controlling blood sugar levels in diabetic patients is not a popular recommendation by clinicians due to the fact that it lacks good studies to support its claims that it is indeed effective and safe to apply in diabetic patients due to the fact that diabetic patients are maintained with antidiabetic medications and are prone to develop hypoglycemia ( blood sugar is abnormally low and is less than or equal to 80mg/dl ).

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The most popular Intermittent fasting schedule is done with or without intake of 500 calorie meal for 24 hours on two nonconsecutive days or every other day per week regimen or fasting for 1-4 days a week with no more than 700 calorie meal taken per fasting day and only allowed to take bone broth, water or juice per fasting day.

Intermittent Fasting Studies:

One a day meal or OMAD-is an example of intermittent fasting diet.

Few or roughly seven studies had been done in intermittent fasting associated with type-2 diabetes mellitus and five are

randomized trials with less than 65 patients involved in each study trial,so it was only tested in a small group of

poplation.The studies intermittent fasting schedule was 18 to 20 hours fasting a day for two weeks, 1 day fasting 2x weekly nonconsecutive days for 12 weeks or 12 months duration, or 3 to 4 days weekly for 7 to 11 months duration, or a 12 weeks duration with 4 days fasting per week and 17 days fasting in months time duration.

According to the results of the studies,there was an improvement of the patients blood sugar levels,normalization of the patient’s blood pressure, decreasing HbA1c result to normal range and showed patient’s quality of lfe improvement.

Some of the results are non inferior to caloric restriction regimen for diabetes patients but the downside feedback of the studies are frequent episodes of hypoglycemia which far more fatal or dangerous if it happens to old diabetic patients with several comorbidities.

The wide glucose variability or fluctuations is hazardous because there is hypoglycemic episodes during the intermittent fasting state and there is hyperglycemia in the feeding state and this glucose variability can result to microvascular and macrovascular complications( acute coronary syndromes or heart attack ).

Cardiovascular risk of patients with Type 2 diabetes.

 

Therapeutic or Medical Intermittent Fasting Study:

Other studies done to some type 2 diabetes patients using (24 hours per day,3x a week)) medical or therapeutic intermittent fasting( 840 calories/day ) resulted to weight loss of 10 to 18%, decreased waste circumference 13 to 22%.

Normalization of patient’s blood sugar including lipid profiles and subsequently decreasing the number and dosages of the patient’s oral medications.

Other patients totally stopped their antidiabetes medication intake and some patients stopped their daily insulin intake/injections for diabetes for 5 to 18 days duration.

Also noteworthy to mention was that, all the patients and participants of the study underwent a 6 hours nutritional lectures before the study formally started.

No adversed event  was noted and importantly, there was no episodes of hypoglycemia noted to all the patients that participated in the study.

Therapeutic or medical intermittent fasting is defined as the controlled and voluntary abstinence from all calorie-containing food and drinks from a specified period of time. Starvation refers to non-deliberate or nor controlled fasting state.

The Author’s Personal experienced and Opinion of the Matter:

I personally applied Intermittent fasting almost every day by using a 6 to 10 hours duration…that means you have a low caloric intake in-between that 6 to 10 hours duration and sometimes you will only consume low calorie fluids such as water and soups,then you will have a measured low calorie main diet to be consumed twice a day…one at breakfast time and the other meal at supper time. If ever you are hungry…then you can have or take a low calorie snacks in between especially at late nightime, which we ourselves designed the snacks or food inorder not to increase the next early morning blood sugar. And result of intermittent fasting was overwhelming and we really felt and experienced the multiple positive effects in our lives. And to such extent that we ourselves designed several daily exercises regimen that will and can work even we are on intermittent fasting state, but I Have to STRICTLY reiterate this one that  intermittent fasting regimen and exercises ” MUST BE PATTERNED or TAILORED FIT ” to the individual person or patient’s need to make it work and avoid deleterious effects to one’s health.

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But I strictly adviced my patients to monitor their blood sugar regularly especially if they have signs and symptoms of hypoglycemia or the abnormally very low blood sugar thing. Symptoms of hypoglycemia are cold clammy sweats,blurring of vision,restlessness,hand tremors,hunger pangs,dizziness,headache,near syncope,increase blood pressure,vomiting or worst is loss of consciousness and seizure attack.

In patients with chronic illness or with longstanding diseases or with other comorbid factors…MY ADVICE is before subjecting yourself to intermittent fasting…YOU MUST SEE YOUR PHYSICIAN FIRST FOR ADVICE…and wait if your physician will allow you to apply such regimen, because the process of intermittent fasting also had adverse effect to your health. And that inorder to avoid such deleterious effect of intermittent fasting, then the process shoud be closely manage and meticulously supervise by your physician of choice.

Conclusion:

That intermittent fasting especially therapeutic intermittent fasting can lower elevated blood sugar level to normal values.

And that it can also results to weight loss and drecrease waist circumfernce and can correct obesity and normalization of previously abnormally elevated serum triglyceride and bad cholesterol levels in diabetic persons.

Intermittent fasting can also be considered a cost effective treatment regimen or strategy to be applied as a dietary  intervention or augmentation treatment for patients with type 2 diabetes disease as it showed more remarkable reduction of patient’s elevated blood sugar versus the standard pharmacological treatment.

 

Although intermittent fasting is unfrequently use or maybe not use at all in the treatment regimen for the management of diabetes disease, but with proper medical supervision and continous blood sugar or glucose monitoring (CBG) can decrease or prevent adverse events cause by glucose variability and hypoglycemia.

And that the result of good blood sugar control through well supervised intermittent fasting will also lessen or prevent acute and long term chronic multi-systemic complications of the disease in diabetic patients.

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Laertes B. Amihan MD

About the Author:

Dr. Laertes B. Amihan is The Chief Clinician Of Celt Medical Clinic And Pharmacy ( Diabetes care and wellness clinic).

Internal Medicine- diabetes care

Occupational Health Physician

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