Fluid Balance in diabetics during

Ramadan
BY

DR . ABDELRAHMAN A MOUKHTAR

Consultant Internist @ KSAFH

2018
 Total Body Water
About 75% of Body Weight

Adult has 45 litres of water in the body:

Intracellular
30 Litres

Extracellular
15 litres
Tissue Fluid 12L Plasma 3L
 Water gains and losses

Gains Losses
Water 1300 ml urine 1700 ml
Food 1000 ml insensible losses ..
Metabolism 400 ml faeces 200 ml
lungs 300 ml
skin 500 ml

Total 2700 ml 2700 ml

During fasting hours when no food or drink is
consumed, the body uses its stores of
carbohydrate and fat to provide energy once
all the calories from the foods consumed
during the night have been used up.
BUT ???????????
The body cannot store water
How efficient is this???
During the daylight hours of Ramadan fasting, practising
Muslims are undoubtedly dehydrating at a rate that is
determined by the loss of body water minus the amount of
metabolic water that is produced over this period.

Acute changes in total body water are best characterized by

repeated measurements of body mass.

Several studies have indicated that healthy individuals who refrain from food
and drink during the daylight hours of the month of Ramadan dehydrate.The
water deficit is, however, corrected at least partly by the resumption of eating and
drinking at the break of fasting during the night hours from sunset to sunrise
Fluid balance parameters measured during weekly periods before, during and after
Ramadan

Euhydration was maintained by a drop in non renal losses (Leiper & Prastowo, 2000).
In a study on 16 Sudanese healthy males aged 20–22 years,

urine output was significantly lower than in the prefasting and post-Ramadan
fasting periods and continued to fall as fasting proceeded .

In contrast, urine osmolality tended to increase throughout the month of

Ramadan and became markedly elevated at the end of Ramadan.

(Mustafa et al, 1978)

 In another study in 20 Malaysian Ramadan fasters aged 20–45 years, the
afternoon urine collection (12:00–16:00) was constantly lower
than the prefasting levels throughout the month of Ramadan .

However, overnight urine output (16:00–08:00 of the following day) remained

unchanged .

On the other hand,

urine osmolality in the morning (08:00–12:00) and afternoon (12:00–16:00)
samples, which corresponded to the abstinence period, was very high.

These findings indicate effective water conservation both by maximal urinary

concentration and reduced urine output.

Further, the relatively constant dilute osmolality of the urine during the overnight
periods demonstrates that the subjects were adequately rehydrated during the night
hours.
(Shirreffs, 2003)
Several alternatives have been used to give estimates of
hydration status of individuals
 Despite these minor changes
• No detrimental effects on health have
as yet been directly attributed to
negative water balance at the levels that
may be produced during Ramadan.

Leiper et al, European Journal of Clinical

Nutrition (2003) 57, Suppl 2, S30–S38.
How about the
Diabetics???
RECOMMENDATIONS

R/
 Water gains and losses

Gains Losses
Water 1300 ml urine 1700 ml
Food 1000 ml insensible losses ..
Metabolism 400 ml faeces 200 ml
lungs 300 ml
skin 500 ml

Total 2700 ml 2700 ml

 Recommendations
Maximize Gains Minimize losses
&
Recommendations

Maximize Gains
1)Drinking enough water throughout the night:
An easy way to remember to drink water is to associate it with a common,
daily act. ( phone ring , commercial advertisement , between prays )

Drinking your water in one go will cause your body to flush it out soon
after. It’s best to sip water throughout the non-fasting hours of the day
2) Consider the water content of the
foods & beverages:
Recommendations

Minimize losses
Minimize losses
1) Control your blood sugar to avoid Osmotic
diuresis

Food that contains a lot

of sugar (such as Ramadan sweets) can really dehydrate you, while
fruit is perfect for providing extra water. So, instead of ending your iftar
feast with piles of sweets, eat a couple of slices of watermelon or an
orange.
 Minimize Renal losses

2) Avoid drinks containing caffeine (especially

at Sahour)

Caffeine has a diuretic effect

that increases urine production, thus flushing out salt and water from the body.
3)Avoid spicy or salty food
Minimize extra renal losses by (sweating):
 Be careful when picking your daytime clothes during Ramadan. The color
of 
your shirt,
Avoid the fabric
undue of your
exposure pants,
to heat and the
during daylayers
time. of clothes all play an
important role in keeping your body temperature as low as possible.

 Cold showers. Cold showers help in many ways to rehydrate you during
the month of Ramadan.

 If you are in an office, wet a small towel with ice water and apply the
towel to your forehead, the area around your ears, the base of your neck,
the upper back, and the chest.
Avoid intense exercise during day time.
LAST and by no means the LEAST
• Never to ignore your body needs.

If you ignore your body

signals this is the worst
mistake in any fast .