Antrian playlist

Dr. Ira Rizanty, IBCLC - Dampak Buruk Penggunaan Dot bagian 1

Dr. Ira Rizanty, IBCLC - Dampak Buruk Penggunaan Dot bagian 2

Dr. Ira Rizanty, IBCLC - Mengapa Harus Menyusui bagian 1

Dr. Ira Rizanty, IBCLC - Mengapa Harus Menyusui bagian 3

Dr. Ira Rizanty, IBCLC - Mengapa Harus Menyusui bagian 2

Inisiasi Menyusui Dini - dr. Gita Paramita bagian 1

Inisiasi Menyusui Dini - dr. Gita Paramita bagian 2

Inisiasi Menyusui Dini - dr. Gita Paramita bagian 3

Persiapan Menyusui di Masa Kehamilan - dr. Gita Paramita bagian 3

Persiapan Menyusui di Masa Kehamilan - dr. Gita Paramita bagian 2

Persiapan Menyusui di Masa Kehamilan - dr. Gita Paramita bagian 1

dr. Endang M Johani, SpM - Katarak Part 3

Puasa Ramadhan yang Aman dan Sehat Bagi Penderita Diabetes || Dr. Tasykuru Rizqa, SpPD

Name: Puasa Ramadhan yang Aman dan Sehat Bagi Penderita Diabetes || Dr. Tasykuru Rizqa, SpPD
Description: Video Puasa Ramadhan yang Aman dan Sehat Bagi Penderita Diabetes || Dr. Tasykuru Rizqa, SpPD dari Radio Silaturahim.

Rasil TVDipublikasikan:

Transkrip diambil dari YouTube. Klik timestamp biru untuk melompat ke posisi tersebut di pemutar.

Braille In the name of Allah, the Most
Gracious, the Most Merciful. Peace be
upon you, and Allah's mercy and
blessings, brothers and sisters beloved
by Allah the Almighty. I hope today
finds you in much better condition, not
just physically but also emotionally. I
hope our time together in this health
space will make us more prepared to
face anything that might affect our
well-being. And for this afternoon, I
hope the discussion will be very, very
helpful. Of course, we also send our
prayers and peace to our prophet, the
beloved of the ummah, Muhammad, may
Allah bless him and grant him peace,
along with his family and kin. For this
afternoon, brothers and sisters, we
have a guest who was here—when was it
? It’s been a while, but she is
warmly known as Dr. Iis. Her full name
is Dr. Taskuru Rizka, an internal
medicine specialist. She is from Mersi,
and if any of our family members happen
to have health issues related to what
we will discuss, I hope we can use this
as a guide for everyone at home. Let's
greet her. Peace be upon you, and
Allah's mercy and blessings, Dr. Iis.
And upon you be peace, and Allah's
mercy and blessings, Mrs. Nuning.
Thank you for joining us in our health
space. And as we discussed yesterday,
fasting is coming up very soon.
Now, Ramadan is surely a significant
event for us all. Especially in the
field of health. What if there are
family members who need to know how to
fast? Now, specifically for today,
regarding Ramadan—a safe and healthy
Ramadan fast for whom is our discussion
?
Specifically for diabetes patients,
Mrs. Nuning. Because as we know, for
diabetes...there are certain risks if a
diabetes patient fasts, especially
since they use medications that lower
their blood sugar levels daily. So,
imagine, they are fasting, not eating,
and still taking their diabetes
medications. Now, that can actually
cause side effects, consequences that
can occur if not well-prepared ahead of
Ramadan fasting. Yes.
The effect could be that their blood
sugar drops significantly, right?
Okay, brothers and sisters. Our
specific topic is how the fast we are
about to observe can be safe and
healthy for diabetes patients. Okay,
please go ahead, Dr. Iis.
Well, thank you, Mrs. Nuning, for the
opportunity. Perhaps I will share a few
slides to make it easier to explain.
With both audio and visual, it is
studied that people receive information
better that way.
Okay. Right. Excuse me, I haven't been
enabled to share my screen yet, Mrs.
Nuning.
Could I get some help so I can share my
screen? Maybe make me a co-host? Yes,
yes, yes.
Right. It has been clicked. Please
proceed.
Oh, right. Okay. Can you see the slide
now?
Ramadan Mubarak. Yes.
Yes. As Mrs. Nuning said, the fasting
month comes only once a year. So, it is
highly anticipated. Who doesn't miss
Ramadan? When Ramadan is approaching,
you're bound to think, "Oh, Ramadan is
almost here." Like that. Surely, people
prepare themselves to be able to
observe the Ramadan fast better. So
they can fast for the full 30 days and
perform worship as best as possible
during Ramadan. Now, this time I will
discuss some tips—well, not exactly
tips, but a bit of knowledge and maybe
some tips and tricks for diabetes
mellitus patients who will be fasting.
Yes. So here is the guide for Ramadan
fasting for type 2 DM patients. Yes.
Well, we know that Ramadan fasting is
one of the five pillars of Islam, an
obligation for all Muslims who have
reached puberty, and it is a time for
reflection and drawing closer to God as
commanded in the Quran. Everyone surely
knows this verse, Surah Al-Baqarah
verse 183. Which means, O you who have
believed, fasting is prescribed for you
as it was prescribed for those before
you, that you may become righteous. But
it turns out that the following verse
explains that whoever is ill or on a
journey, then he should fast a like
number of other days. Allah intends for
you ease and does not intend for you
hardship, and wants you to complete the
period and to glorify Allah for that to
which He has guided you, and perhaps
you will be grateful. Yes, so whoever
is sick may skip fasting, but they must
make up for it later or pay fidyah, and
so on. He
yes. So, what exactly is diabetes?
Perhaps not everyone knows what
diabetes is. Although some people
already know. It is more popularly
known in society as "sweet urine"
disease. So, this sweet urine condition
is when the blood sugar level in the
blood is high. Why is the blood sugar
in the blood high? Because there is
damage to an organ called the pancreas.
Beside our liver, behind the stomach,
there is an organ called the pancreas.
Now, this pancreas
produces insulin. In diabetes, this
insulin is not released because the
pancreas is damaged, or sometimes it
has become resistant to the existing
insulin. So, the insulin exists but
cannot enter the cells to help break
down the blood sugar. It can't do that.
So, that is what causes diabetes. This
is the pancreas organ. Its projection
is more or less behind the stomach,
below the liver. This is the liver,
this is the intestine. It is located
somewhat in the middle.
Well, when we fast, the sugar in our
body is low because we aren't eating.
Then, if there's little sugar in the
body, naturally less insulin is
released, because insulin is released
when we eat. Since there is less
insulin, our body makes an adaptation,
what you might call an adaptation. In
the body, it breaks down the sugar
reserves stored in the liver. For
patients with diabetes mellitus, if
this keeps happening, it's not just the
sugar in the liver that gets released,
but fatty acids are also released from
adipose tissue, leading to fatty acid
oxidation and the formation of ketone
bodies. These ketone bodies can be
dangerous for people with diabetes who
are fasting. For healthy patients,
there isn't really a risk like this.
With a high level of ketone bodies, the
patient can become weak, dehydrated,
and even lose consciousness because the
blood becomes acidic. This is because
it's an oxidation of fatty acids. Also,
when fasting, as I mentioned, glucagon
levels rise, and catecholamines also
rise. Now, glucagon is a hormone
located in the liver. If the sugar in
the blood is already low, what does it
do? It produces and breaks down
glycogen, the sugar reserves stored in
the liver. So, the effect can actually
be that if blood sugar is broken down
continuously because the body's
metabolism is already erratic. In the
end, it's broken down constantly, so
the blood sugar levels become high. So,
in diabetics, blood sugar can actually
get too high when fasting. The body can
also become too acidic. It can also
happen that because they fast, eat
suhoor, and take medication without
knowing the rules, the blood sugar
becomes extremely low until the patient
becomes weak. So, it's like a
double-edged sword. It can drop, but it
can also spike to very high levels. So,
there are risks of hypoglycemia,
hyperglycemia, and ketoacidosis, as
mentioned before, because the body is
stimulated to constantly break down the
sugar from the liver. As a result,
blood sugar levels rise, and fatty
acids from fat reserves are broken down
to form ketone bodies, leading to
ketoacidosis. Also, dehydration can
occur if blood sugar levels are too
high. Because high blood sugar tends to
draw out fluids, causing our cells to
become dehydrated. This leads to
dehydration and thrombosis, where such
conditions make it easier for clots to
form. We know that sometimes diabetes
patients don't just have diabetes, they
have other complications like a stroke,
or a history of stroke but can still
walk, or perhaps a history of heart
disease as well. Now, this is actually
very risky for, uh, fasting, as it
could lead to thrombosis or the risk of
new blockages during the fast. Right.
So, here it is. For example, if I have
a diabetes mellitus patient one month
before, uh, the fasting month of
Ramadan, like now. This month of March
is when I have to remind my patients
again. Right.
Uh, whether if they fast, the risk is
very high, high, moderate, or low? What
is considered a very high risk? If, for
example, they’ve had their blood
sugar drop, hypoglycemia, in the last 3
months and it happened repeatedly, or
their blood sugar is still not
well-controlled, still at 300 or, uh,
250 and above. That is a very high risk
. Type 1 diabetes mellitus as well.
Type 1 diabetes mellitus means they no
longer produce insulin and must have
insulin added from the outside. This
case is indeed rare. Then, acute
illness, for example, a recent heart
attack, that is actually a very high
risk, or heavy physical labor,
pregnancy, or patients on dialysis—
these are very high risks. For high
risk, the average blood sugar is still
150 to 300. Their HbA1c, if tested,
might be 7.5 to 9. They have kidney
failure but are not yet on dialysis.
Then they have other complications, for
example, coronary heart disease, a
history of stroke, or perhaps glaucoma.
Then, an elderly person living alone
who takes insulin or sulfonylurea-type
medications, which I will explain later
. Uh, this is also considered very high
risk. High risk, I mean. Moderate risk
is diabetes controlled with
glinide-class medications.
Glinide-class medications, as it
happens, aren't available in Indonesia.
So far, I have never encountered those
medications. Right.
Now, low risk is if they are healthy,
their blood sugar is controlled, and
they only use these medications. For
example, metformin, acarbose,
pioglitazone. Or medications that end
in "gliptin". Now, these are actually
low risk and are allowed to fast. So,
we must pay attention because sometimes
every patient is different. For example
, even if they live alone, but the
person is very careful and can, uh,
monitor their blood sugar, or they have
a device at home to check their blood
sugar levels themselves. You know,
diabetes patients usually have that
tool to check blood sugar at home. Now,
this is glycemic monitoring. It's even
better if you have a device to check
your blood sugar. For instance, if they
are fasting and suddenly at 3:00 PM
they feel weak or have a stomach ache.
That could be a sign of hyperglycemia,
where blood sugar is too high, causing
stomach pain or discomfort, or even
heart palpitations and cold sweats. Or,
it could mean their blood sugar is too
low. That's why it's best for diabetes
patients to have a blood sugar
monitoring device at home. Regarding
nutrition, there's a tendency during
the fasting month for people to go
overboard with food during iftar.
Diabetes patients, inevitably, also get
tempted. For example, there might be
fruit cocktails or fried snacks at home
. This is what needs to be understood;
diabetes patients must be reminded to
try to eat as they normally would,
without overdoing it, because the
tendency is to eat too much when
breaking the fast. This is what
patients or Rasil listeners with
diabetes need to be reminded of: try to
keep your iftar meal similar to your
meals before fasting. As for physical
activity, heavy exercise or strenuous
hobbies should probably be limited.
Daily heavy activities may also need to
be restricted. If you were very active
from morning to evening, you should
scale it back, perhaps by resting in
the morning and limiting your afternoon
activity hours. Like at 4:30. That is
important for diabetes patients. If
symptoms like heart palpitations, cold
sweats, or weakness occur, you must
stop fasting. We shouldn't let fasting
put our health at risk. Usually, when
blood sugar drops below 60, patients
feel very weak and unable to do
anything. Yes. Then, heart palpitations
, dizziness, and cold sweats are the
most common symptoms. Those are the
most frequent signs. Or if you have a
device and check at 10:00 AM, and find
your blood sugar is already very low.
You must also stop fasting then, or if
your blood sugar levels are too high,
over 300. As I mentioned before, if
blood sugar is too high, the blood
tends to absorb fluids. So, our cells
will become dehydrated. That creates a
risk of blockages, especially in
patients who already have pre-existing
conditions. Furthermore, if a diabetes
patient suddenly falls ill, it's best
not to continue fasting. Because when
we are sick, our blood sugar tends to
be higher than normal due to stress in
our bodies, yes. Perhaps this will be
clearer here, listeners, you might be
able to see it here, regarding the most
common medications for diabetes
patients. If we want to treat type 2
diabetes patients, the number one
choice is definitely this, especially
if the patient is obese, metformin.
If it is three times a day, it means at
suhoor, take one-third of a tablet, yes
. Then 1000 mg at iftar, take
two-thirds of the medication at iftar
like that. Now, these are medications
that are also often used, especially at
community health centers, numbers one,
two, and four are the most commonly
used. Sometimes this is still here, you
can see, glibenclamide. Who is still
often using glibenclamide? Usually,
community health centers still often
provide glibenclamide or glimepiride,
or sometimes gliclazide, which is quite
rare, or gliquidone.
Now, those who have the medication
should immediately check the name of
the drug before fasting, yes. So, if it
is glibenclamide or glimepiride, it is
generally given once a day. This is the
medication known as sulfonylurea. So
this medication stimulates the release
of insulin. As mentioned earlier, if
the pancreas is damaged, insulin cannot
be released, right. Now, here are
examples of the medication.
Glibenclamide or glimepiride are
usually given in the morning, yes, in
the morning. Since it is once a day, it
shifts to iftar time. Glibenclamide and
glimepiride are taken at the time of
breaking the fast. For gliclazide, it
is usually taken twice a day. So, it is
taken in the morning, right, and it is
80 mg. So in the morning, perhaps just
half, which is 40 mg. Then at iftar, it
remains 80 mg. Gliquidone is the same.
It can be taken two to three times; at
iftar, the dose remains 30 mg. During
suhoor, it is reduced to 15 mg. Now,
for this one, it is called Glucobay or
acarbose. Acarbose does not need to be
adjusted when taking this medication.
Take it at suhoor and take it at iftar.
But at noon, it is not taken if the
prescription is three times a day. This
one is called pioglitazone, Actos, or
Deculin. There are many brands, and it
is also taken once a day at the time of
breaking the fast. I forgot to write
this down, it seems, below this. Now,
these are medications that might be
somewhat rare, somewhat rare for
diabetes patients to use, especially
this one, Forxiga, it is a new drug. Or
drugs that have "gliptins" in them,
like linagliptin or sitagliptin, those
are examples of the medication. These
don't need their dosages adjusted. So,
if the patient takes them twice a day,
they can just take one at suhoor and
one at iftar. No adjustment is
necessary. Now, what about insulin?
Well, there are various types of
insulin. There’s insulin that’s
injected three times a day with meals,
and there’s insulin that’s injected
at night. Here’s an example of
insulin that is injected once a day at
night. What if they usually inject
insulin four times a day? So, the
nighttime insulin is shifted up to the
evening, around iftar time, and then
that insulin is injected. Then, if they
usually get fast-acting insulin in the
morning, afternoon, and evening...The
dosage is cut down to half, half of the
usual dose. Now, for the mix type, this
insulin usually contains both types
combined. Usually, we suggest
temporarily switching to this other
type during the fasting month. So, they
use the long-acting one in the evening,
and the short-acting one in the evening
as well. Then at suhoor, they use the
short-acting one, but the dose is
reduced by half. Yes, it's roughly like
that. I was looking into it yesterday,
and it turns out that the famous hadith
about fasting and health, "sumu tasihhu
," might be considered a weak hadith,
perhaps we should ask an ustadz.
We might need to ask later, but as it
happens, when I was in internal
medicine residency...
my research was about...
the effects of Ramadan fasting on
cardiovascular health. And the results
were good. So, by fasting during
Ramadan, the quality of our blood
vessels actually improves. That’s
more or less the conclusion.
Like that. But the downside is, after
Ramadan, if you go back to your old
habits, the improvements to your blood
vessels disappear. It turns out that
during Eid, people feast, so things
usually go back to how they were. Yes.
Yes. There are many, many studies on
Ramadan fasting. It reduces
inflammation, reduces, uh, what else?
It improves blood vessels. Studies say
that body weight on average tends to
decrease. Lipids go down, blood
pressure goes down, lipids like
cholesterol and triglycerides decrease.
So, regardless of whether that hadith
is authentic or weak, research shows
that fasting is indeed proven to be
healthy.
Yes, that’s more or less it, Mrs.
Nuning. Maybe it would be better if we
have a Q&A session later. I just wanted
to provide a general overview. Thank
you.
Doctor, thank you so much for the
information. Many questions have been
asked, but let's give a chance to those
who need to step out or take a short
break. We will take a break first. We
return to your room, brothers and
sisters, discussing how diabetes can be
managed while fasting during Ramadan,
provided it follows what was just
mentioned. Well, we await your calls or
any WhatsApp messages sent via YouTube
as well. We will be back after this
break. [Break] Thank you for staying
with Rasil for Islam the One, in the
Health Room program with Dr. Iisas Guru
Rizka, an internist from Mercy, who is
discussing the safety of fasting for
diabetes patients. Doc, may we continue
with the questions, Doc?
Okay.
This one is from Liza Emilda who says,
"Thank you very much, West Bekasi is
tuning in." Barakallahu fikum, Rasil.
May you continue to thrive until the
end of days. To be clear, we will also
address the questions that appear on
YouTube later, friends. Then, from this
servant of Allah via WhatsApp: Does
diabetes medication always interfere
with other aspects of health, so that
one must strictly follow the doctor's
orders? Thank you. Yes. Yes. So, if we
have diabetes, we certainly must
consult.
With a doctor, someone who understands.
For those whose condition isn't too
severe, a general practitioner at a
health center might be enough. Of
course, if one is already using insulin
, it requires a more specialized person
to manage it. Now, if someone already
has diabetes. Diabetes is a chronic,
long-term disease that cannot be cured.
It can be controlled. How do we control
it? By managing diet, lifestyle, and
exercise. We will eventually find the
right formula. If possible, using
minimal medication while still
achieving the target blood sugar levels
. Right.
Exactly. So, if someone has diabetes
and is diagnosed but decides not to
take medication, their blood sugar will
remain consistently high.
If left untreated, it will lead to
complications. We know that diabetes
complications can affect everything
from head to toe. That's correct. From
strokes, for instance, or eyes—
developing retinopathy causing blurry
vision—to coronary heart disease.
Also, in severe cases, patients often
experience frequent stomach pain, which
we call diabetic gastropathy, all the
way to foot ulcers where poor blood
flow can lead to worsening wounds. So,
the understanding is that taking
diabetes medication must be consistent
because this disease cannot be cured.
Many people often ask me, worriedly, "
Doc, is it really okay if I have to
take medication for life?" Well, it's
not a problem because that's what
dosage is for. There are levels that
are considered safe for human
consumption. That's why you need to
consult first. For example, don't take
Metformin four times a day or more than
1000 mg. That would certainly be wrong.
If you do that, your kidneys could
actually get damaged from taking the
medication. But when it's taken
according to the correct dosage and
instructions, it won't damage your
kidneys or anything else. In fact, if
you don't control it with medication,
it can cause the complications I
mentioned earlier, causing damage from
head to toe. Yes. Kidneys, kidney
failure, dialysis. Because the most
common causes of coronary heart disease
or kidney failure are often diabetes.
So, if it's not treated, the long-term
effects are catastrophic, leading to
systemic damage. It happens gradually.
That's why it must be controlled,
ideally with the minimum effective
dosage while keeping blood sugar
well-managed. Alright, for those asking
where to call, I will repeat it. Please
call 021-845-151. But if you want to
send a WhatsApp message, you can send
it to 0811 three times. Then 999 also
three times, and at the end 720. Okay,
please go ahead. Someone earlier also
asked about calling, feel free to do so
. Now, a question from Purwakarta, Doc.
From Mr. Dani. Is it okay for a
diabetic to eat honey every day? Asking
for a friend, Doc. Yes.
Right. Basically, diabetes patients
must eat. Don't think that someone with
diabetes mellitus cannot eat rice; they
actually must eat rice. We always
remind patients of the "3J" rule. That
is: eating schedule, quantity of food,
and type of food. If you want to have
honey, is it allowed? Yes, it is
allowed. When can you have it? You can
have it at breaking the fast, or at
suhoor, that's fine.
Because it basically comes down to the
quantity of food. That quantity. Maybe
your rice portion should only be the
size of your fist, more or less. But
not a full, overflowing fist, just a
flat one. People usually refer to a
level measuring spoon rather than a
heaped one. Yes, that's it. Perhaps
that's all the rice you should have.
Then for the side dishes, for example,
during suhoor, you could have fish and
spinach. If you want honey because it
contains sugar, then other things must
be reduced. What should be reduced? The
rice. Because the honey already
contributes carbohydrates and sugar as
well. So, it is allowed, sir. It's the
same for breaking the fast. If you take
a spoonful of honey, maybe the portion
of rice, which was a handful...what do
you call it? A handful. But if your
hand is big, you shouldn't eat a whole
big handful either. Maybe just a pinch,
Doc, fingertips.
A spoonful of rice, like that. A
spoonful of rice, for instance, if your
meal consists of fish, tempeh, and
spinach, for example, at suhoor. Since
you want to consume honey, you should
skip the tempeh. You have to replace it
because they are both essentially sugar
.
Uh-huh. That's allowed, yes. The same.
So, for diabetes patients, you eat
three times a day, sir. O'clock. 12:00
PM, o'clock. At night. On regular days,
not fasting, if you’ve already had
breakfast, you shouldn't eat biscuits
right after. If you want biscuits, have
them at 10:00 AM. Or after lunch, if
you see pudding and think it looks
delicious. Well, you shouldn't eat
pudding right after lunch. You should
push it to the snack time at 3:00 PM.
Like that. Right. For example, at 9:00
PM, that's when you can have your milk.
You shouldn't drink milk right after
your dinner. No, because the sugar
level will spike very quickly. So, you
really must follow the 3J schedule for
eating. So, breakfast, lunch, and a
snack in between meals, right? When
fasting, there are no snacks, just the
evening meal, right? Yeah.
Because during the fasting month,
people tend to be active at night—
there's Tarawih, breaking the fast,
eating, then Isha prayer, and after
that, some sleep and wake up again at
midnight. Sometimes, people get tempted
to eat after Tarawih or late at night
during Qiyamulail, for example.
Yes, just like that. That applies to
the meal schedule and the types of food
as well. So, as we discussed with rice,
the issue is the type of food. Just
like what you asked, if you've already
had rice and want honey, you
automatically have to sacrifice the
rice, or maybe skip the tempeh, just
having fish, vegetables, and rice. Also
the amount of food, as I mentioned,
maybe just one scoop of rice, one piece
of fish, and one piece of tempeh. If
the vegetable is spinach, you can have
as much as you like, as much as the
patient wants. But if the vegetable
dish includes potatoes, squash, or
jackfruit, you might need to reduce it
because the glycemic index is higher.
So, for example, if in the morning you
want to have tea and bread, just have
tea and bread; you shouldn't add
anything else. You shouldn't add more,
"Oh, I haven't eaten rice yet." Typical
Indonesians, they say if they don't
have rice, they haven't eaten. But then
, they end up eating again. That is not
allowed. Yeah.
But that’s for when you're not
fasting. So remember, the amount, type,
and schedule of meals are the most
important for diabetic patients.
Yes. Hopefully, if there's someone at
home with diabetes, we can tell them to
say yes to this. Earlier I heard on
Rasil that Doctor Iis said you can't do
this or that. Wow, that's really cool.
Okay, let's talk about Ramadan fasting,
Doc. Yes, many have just said, "I tried
fasting on Mondays and Thursdays, but
honestly, after Asr, I get shaky." Does
that mean I shouldn't continue, Doc? "
Yes. Actually, if you are already shaky
, have cold sweats, or feel weak, those
are symptoms of hypoglycemia. Perhaps,
Ma'am, you should re-examine how you
are taking your diabetes medication.
For example, if you normally take
metformin three times a day, for suhoor
you might only take one tablet. Then,
have two tablets when breaking the fast
. Perhaps, for instance, that's why I
mentioned individualization earlier.
Each person is different, so we can't
always generalize. That's why
being a doctor is called both science
and art. So maybe, if around 4:00 PM
after Asr you start getting shaky. Just
try skipping your diabetes medication
during suhoor when you are fasting. How
is that? Is it good or not, or maybe
what are you eating for suhoor? Because
sometimes the mindset of a diabetic
patient is," I'm not eating, Doc, "but
that is actually wrong. Diabetic
patients must eat because our bodies
need energy. But they must adhere to
the three things: type, schedule, and
amount of food. If there are symptoms
of shaking, cold sweats, or heart
palpitations, it is best to break your
fast, because those are signs that your
blood sugar is dropping. A drop in
blood sugar is actually more dangerous
than having high blood sugar. Because
if blood sugar is too high, it
sometimes takes a day or two for a
person's condition to worsen. But if a
person is hypoglycemic, their blood
sugar drops, it can be extremely
dangerous within hours and even
life-threatening, Ma'am. Yes, so you
must be careful. It's even better if
you have a blood sugar monitor. So when
you are shaky, your blood sugar is
below—yes. Already below
100, or below 70, you are obligated to
break your fast. You shouldn't continue
because, as I said, fasting is
mandatory but there are exemptions for
those who are truly unable. The
difficulty is that, theoretically, if
you're on insulin four times a day, you
shouldn't be fasting. But Indonesian
people are, uh, how should I put it?
Their enthusiasm for fasting is very
high, Mrs. Nuning. So, for me, to the
patients,
well, I understand that, so I don't
forbid them from fasting, but I
strictly emphasize how to use the
insulin properly. So, ladies and
gentlemen, brothers and sisters who
have diabetes, this month is the time
to consult your doctor about how to
take your medication, especially
insulin. Oral medication is easy, like
glimepiride, which is most often taken
in the evening. For metformin,
one-third at suhoor and two-thirds at
iftar, that's easy. But for those using
insulin, you must consult again about
the dosage, or perhaps you need a
temporary change in the type of insulin
, Mrs. Nuning.
Regarding insulin, there is a question:
since it's injected and doesn't go
through the throat, it doesn't break
the fast, right? Since it's not eaten,
just injected. So, how do you explain
this, Doctor? Insulin is a drug used to
lower blood sugar, right? It is
injected during suhoor.
Like that. It's fine if it's injected
during suhoor. Because insulin is a
medication that, as I mentioned, maybe
I'll try to show what it looks like so
you can visualize it. So, insulin is
not taken orally but injected. Here,
this is an example of insulin. Now, if
you open the cap, I forgot to take a
picture of it yesterday. When the cap
is opened,
you open the cap here, and there is a
needle right here. The needle is
replaced every time you inject, or
sometimes people change it once a day,
like, used three times then replaced.
There is a needle, so it’s impossible
to put it down the throat because the
medicine is absorbed through what layer
? The subcutaneous layer.
Understood. Okay. Perhaps what is meant
, Doctor, is that if insulin is
injected, it doesn't break the fast,
right? So, if you inject insulin while
fasting, is it okay, or are you saying
that would break the fast, Doctor?
Oh. The insulin is injected at suhoor,
before fasting begins. Yes. Actually,
some inject four times, Doctor. For
those who inject four times, that's why
I said you must consult a doctor.
Usually, if they inject four times,
it's short-acting insulin, taken in the
morning, afternoon, evening, and then
before bed, right? So, those doses are
shifted to the evening when breaking
the fast. Just inject it, like 10 units
for example. The doctor says, inject as
usual, and this one could be, for
example, 3 times 5, right? You get
injected too, that's five, boom, five.
That's right after we break our fast.
So, actually it has nothing to do with
it.
During the day we're fasting, so Mrs.
Nuning doesn't get injections then.
She doesn't get injected three times a
day, but for example, at sahur, the
dose is usually 10 units. Now, because
of the fast, it's injected at half the
dose. So, for example, 5 units during
sahur. So actually, the injections
aren't given while fasting. As for
people, I'm not sure, maybe this is
more about sharia or fiqh.
Whether it invalidates the fast or not,
but after all, it's not injected while
fasting, it's done at sahur and at
iftar. More or less like that.
Alright, a question from Banten from
Ms. Sari. Doc, is amputation the only
way to stop diabetes from spreading?
Uh-huh.
This happens very often. So, actually,
when we face a problem with wounds in
diabetic patients, number one, if the
wound is already very bad, then, you
know, there's an infection, for example
, they have a fever, their leukocyte
count is very high, then like it or not
, it must be cleaned. Cleaned, but
before being cleaned, it must of course
be examined first. The examination
usually involves an X-ray. An X-ray,
what do you call it? If, for example,
there is an infection that has reached
the bone or what we call osteomyelitis,
then of course it must be amputated. So
not everything. We cannot generalize.
Everything is like that. First, blood
sugar control must be good. Then, how
about the wound? Can the wound just be
cleaned, or if the infection only
reaches the muscles, it's usually just
cleaned. If it has reached the bones,
we have to amputate. Especially if it
has become gangrenous, where it's
already necrotic, then we really have
to amputate. Then, we should also check
the blood vessels, either with an
ultrasound or, in big cities, an
angiography; sometimes the problem
isn't just an infected wound. Usually,
sometimes the blood vessels are already
bad or blocked in the legs. For cases
that already have blockages, the blood
vessels must be repaired. For example,
by placing a stent. So placing a stent
isn't just for the heart anymore
because of advanced technology. So a
stent can be placed in the small blood
vessels in the legs if there is a
blockage.
And does the patient need specific
medications to help ensure the blood
vessels don't get worse? So every case
is very individual. We must examine it.
Not everyone with diabetic feet needs
amputation; not everyone needs an
examination or a vascular stent
procedure. Not everyone needs to take
medication for poor blood circulation
in their feet, either. So, it is very
much a case-by-case basis. Each case is
truly very different. But, the number
one priority is still to prevent foot
wounds. That's why you shouldn't wear
tight sandals, for example. In fact,
you should try to wear sandals even
when you are at home. Because sometimes
the downside for diabetes patients is
that they don't feel anything. They
might step on something and get a wound
without feeling it, only realizing it
when it's bleeding due to nerve damage.
It's pretty much like that.
Right. Here is a question. Hopefully,
this information from an anonymous
sender is helpful." Doc, may I ask
about my wound? I happen to be a
diabetic who consumes fermented milk
like yogurt. Surprisingly, why is it
drying up, Doc? Even though I'm still
taking my medication. Does fermented
milk also have an effect on slowing
down the spread of the wound? Thank you
. "Yes.
Oh, this is new knowledge for me.
Honestly, I haven't read anything about
whether fermented milk is actually
beneficial for wounds. But honey has
been proven effective for wound care
and tissue regeneration. However, if
it's about milk, I apologize
that I haven't read about it. This is
actually new information. Perhaps I
will try to look into it first, Ma'am.
I'll read up on it. Yes. Sometimes
there really are many studies using
what you might call new sources.
Right. Because incidentally, milk is
something healthy anyway. They try
something like this,
and the results are like that. This is
interesting information. Okay, Doc.
Moving on to Mr. Amir Zaki Mubarak, who
asks," Can an insulin injection still
be used if it hasn't been used for a
long time and wasn't stored in the
refrigerator? If it's not used, what is
the safe way to dispose of it, Doc? "
Oh, yes, that's correct. If it has been
opened, it will go bad if it's not kept
in the refrigerator. So, it can no
longer be used. Regarding disposal, if
it's just the insulin without the
needle, you can throw it in regular
trash. But we always remind you about
the needles, saying," Ma'am, please
collect your needles. "When you come to
the hospital, bring them so they can be
disposed of there, or take them to the
local clinic for disposal. Because they
are infectious, so they must be
destroyed differently, not in a regular
trash can, as they would be dangerous
to others, of course.
Exactly. Yes. So, if insulin has been
unsealed and not stored in the
refrigerator, it cannot be used. The
refrigerator downstairs, not the
freezer one, it's broken and can't be
used, so it has to be thrown away.
Alright, let's continue with this next
one from Mrs. Sunarsih. Wait a second.
Oh, no. Wait a moment, please. Mrs.
Sunarsih is asking. Sorry, this is
off-topic, Doctor. If one has a history
of heart palpitations, is it safe to
fast during Ramadan? Doctor?
How was that, Ma'am? Sorry. Earlier.
Having a history of palpitations.
It’s breaking up. Oh, yes.
Is it safe to fast or not?
Are the heart palpitations due to
diabetes or something else? Well,
actually, if someone is fasting and
experiences palpitations, it could be
that it's diabetes, but their blood
sugar is dropping.
Palpitations are one of the, what is it
? One of the.
Indications.
Yes, an indication that blood sugar is
dropping. However, if the palpitations
are caused by other things, for example
, most commonly in thyroid disease, the
complaint is often palpitations. Then,
another example is heart disease with
rhythm disorders, that also causes
palpitations as well. So, it must be
investigated first, you see. Perhaps
just consult a doctor:" I have
complaints of palpitations, can I fast?
"Usually, if it is indeed due to
thyroid issues or heart rhythm problems
, as long as routine medication is
still taken, it should be fine to fast.
Okay.
Unless it's in an acute condition, for
example, having a recent episode of
palpitations where the heart rate
reaches 200, so you've just been
treated, then, of course, do not fast
yet.
Alright, let's go to Banyuwangi, Doctor
. There is Ms. Pratvi who asks," Doctor
, why can small children get diabetes
now? "" Please enlighten me. "Yes.
Yes, that's right. In small children,
diabetes is usually type 1 diabetes
mellitus. So they can't use regular
medicine; they will use insulin because
the damage is that their pancreas is no
longer producing insulin. Then, there
are also those in their teens or around
20 years old. So there is something
called diabetes mellitus that is...LADA
and MODY. I happen to forget the
late-onset, I forgot the abbreviations,
but essentially, it is indeed diabetes
at a teenage age, or young age in the
20s or teens, that can happen. Uh-huh.
It’s called LADA or MODY, it does
exist, and it has factors related to
genetic issues as well; there are more
detailed examinations for that. But
usually, for the young ones, it's a
type of diabetes where the damage is
from the pancreas not being able to
produce insulin. So, indeed, the
medication will be more toward insulin.
Usually, we try medication and they
don't respond, for example, those who
are in their 20s and already have
diabetes, they don't respond to
medicine. Blood sugar levels keep
spiking and only stabilize after
insulin. For young children, for
example, aged 3 or 4 years old. That is
most likely type 1 diabetes mellitus.
This really requires specialist
treatment, yes. Perhaps you should
consult a doctor first. If they want to
fast, the risks are very high.
Yes. Because for children, usually a
pediatrician checks their blood sugar
very often throughout the day.
There may need to be stricter
requirements because they are very
dependent on insulin. The danger is
that if they aren't given insulin,
their blood sugar will be too high.
Like I explained before, they can get
dehydrated and ketone bodies can build
up in the body. So our body becomes
more acidic because lots of fatty acids
are broken down from our fat tissues.
It is very dangerous because
ketoacidosis is life-threatening,
really, life-threatening. So you need
to consult further with the doctor who
treats them daily, as they know the
blood sugar patterns best.
Okay, let's move on to a question many
people might also have. If someone
wants to marry, and my family has a
history of diabetes from grandparents
to my parents. If the future partner
also has diabetes, is it dangerous, or
should we find a partner with no
diabetes at all? Please advise, Doctor.
Yes, please go ahead.
Yes, that's correct. Diabetes is indeed
hereditary. If our parents have
diabetes, the chance for their children
to have it is also high. So, I will
return this to the people who are
getting married, Ms. Nuning. If you
suddenly already...
If you're already deeply in love, then
no.
If you already like each other, you
wouldn't cancel it just because you
both have diabetes, right? Perhaps I
will return that to you. But it is true
, if only one person has diabetes, the
risk for the children is smaller. But
if it's the grandparents, father, and
mother...
It's highly likely the children will
have diabetes.
Especially if the husband also carries
the diabetes trait. It is very possible
, very possible that their children...
Maybe 70%chance of diabetes, that could
happen. But there is a chance, since we
don't know if they fall into the 25%
bracket, right? But diabetes is a
disease that can be controlled as long
as the treatment is good. Good and,
well...You also have to be diligent.
Sometimes I have patients who have had
diabetes for about 40 years, but
because they are very diligent, even in
their old age, at 70, I still consider
it successful aging. So they are aging
well, with, um, no obstacles, no wounds
or anything. Because this patient truly
understands what diabetes is like,
takes medication, and happens to be
able to check their own blood sugar at
home. So actually, if you are diagnosed
with diabetes, it’s not the end of
everything, it’s not the end of
everything. Yes, because it can be
treated.
Okay, I will head over to South
Tangerang, Mr. Muhammad, monitor. Then
also Ahmad Salim who asked for the
phone number earlier, 845 1512, if you
really want to call directly. And also
in Cianjur, Mr. Sepi Juana, thank you
for always listening to Rasil. And
regarding Mr. Amir's question earlier
about returning insulin or needles to
the hospital because the patient has
passed away, Ma'am, should the insulin
and needles be returned to the hospital
or thrown away, based on the previous
question?
Oh, right, if it's been a long time,
just throw it away. If it's the needles
, take them to the community health
center or hospital so they can be
incinerated. So the disposal of needles
is different. It's specific. Uh-huh.
Okay. Then the next question. Wait a
minute. Eh, where was it? From Tegal.
From Mas Anto. Is it true that someone
with diabetes has to take medication
for how long exactly? For their whole
life, right? Yes. It’s for life;
diabetes medication is taken for life
because it doesn’t go away, it's just
controlled. But usually, it can also
happen that, for example, their blood
sugar profile was very bad at the
beginning. For instance, they initially
used insulin, but by improving their
lifestyle and diet, they might
eventually only need to take oral
medication. So yes, you have to take
diabetes medication for life. Except,
for example, in patients with kidney
failure. Sometimes
they initially used medication, but
because they are on dialysis, their
kidneys, which normally filter out the
medication, are damaged. So the
concentration of the medication stays
in the body longer, or the insulin
circulates longer because it isn't
being filtered out by the kidneys. Now,
in kidney failure patients, sometimes
they can go from taking diabetes
medication to not needing it. But for
other patients, they will still need
diabetes medication for their entire
life. The important thing is the right
dose, the right usage, so
what people worry about is," Doc, I'm
taking so much medication. "It's okay,
it's okay. Because it already has its
prescribed dose. That is the purpose of
the dosage. If they don't take the
medication, it's actually even more,
what? It's just like what I said
earlier, right? Complications appear
silently. Suddenly you have a stroke,
suddenly a heart attack. We just don't
know. We might seem fine on the outside
. That is exactly what we want to avoid
. We must not let those complications
happen. So, truly be a healthy diabetic
. There are many healthy diabetics out
there. So don't worry, as long as you
consult the right person.
Okay, before we summarize today's
discussion, Doctor, there are greetings
from Ms. Anggit Andayani. Grateful to
be able to follow Rasil and also from
the thumbs-up on YouTube. Okay, Doctor.
We are at the end of the show, please
summarize how it is safe for diabetics
to fast. Provided that. Yes.
Yes. Well, this month of fasting is the
most awaited month. The month that we
look forward to. For diabetics, of
course, you need different preparations
compared to normal people. Because we
know fasting means we don't eat, we
don't have blood sugar intake. Whereas
we have a disorder in the organ that
regulates blood sugar. So, to all the
gentlemen, ladies, brothers, and
sisters who are having their doctor
check-up this month, if you have
diabetes, please consult...Consult
regarding how your treatment should be.
Yes, I fully understand that in
Indonesia, the spirit for fasting is
very high. Even if it's said," Sir,
it's high risk to fast, "people still
want to fast because it's that one
month in a year that we wait for. And
that month is indeed our time for
reflection and worship. So, I
understand that. The point is, you must
still maintain a healthy lifestyle.
Then discuss the issues with your
doctor this month on how to adjust your
medication, and God willing, you can
fast safely and comfortably, as long as
your condition is healthy and you have
followed the doctor's instructions. God
willing, you can fast healthily, safely
, and comfortably; don't be afraid. The
important thing is to have had a
discussion first. So, to be safer,
adjust your medication dosage and
timing so there are no mistakes, and so
you don't miss our happy moment of
worship during that month. Thank you,
Ms. Nuning.
Thank you, Dr. Iis, whose full name is
Dr. Tas Guru Rizka, an internist from
Mercy. Hopefully, through fasting,
there will be improvements in
inflammation, blood pressure,
cholesterol, and triglycerides. Fasting
truly has an extraordinary effect. It's
clear that those listening and watching
now know how diabetics can safely fast.
Hopefully, it is beneficial. Once again
, thank you, Dr. Iis. Hopefully, we can
be together again next time. But before
I leave this show, there is something I
really want to convey regarding whether
any of you have children or family
members who want to memorize the Quran
in one month? Is that even possible?
And as it turns out, if you join the
webinar on memorizing the Quran in one
month, it will be filled by speakers
Ustaz Husein Alhadad, Ustaz Husein
Alatas, and also Dr. Munif Khatib at 10
. 11:30 on the upcoming Sunday, March
6th. Yes, this upcoming Sunday, March
6th, from 10:00 until 11:30. Space is
very limited, so as soon as possible,
go ahead and register. You can note
down the info. Please call 0812 2709
2907. Once again, 081227092907. Thank
you once again, Dr. Iis. Regards to the
family, and greetings to the friends at
Mercy. We look forward together to the
fasting month which will be here soon.
Thank you. Billahi taufik wal hidayah.
Wasalamualaikum warahmatullah
wabarakatuh.