Fasting For Mellitus Diabetes Children Is Full Of Challenges, But That Doesn't Mean It's Impossible

JAKARTA Fasting can be very challenging for people with diabetes mellitus, especially children and adolescents.

Ramadan fasting is a service that must be carried out by all Muslims. At this moment, usually children who are already tamyiz (can distinguish between good and bad) but have not been slow to start learning to follow Ramadan fasting, while in good health.

Chairman of the Central Executive Board of the Indonesian Pediatrician Association (IDAI) Piprim Basarah Yanuarso said that training children to fast can be done from an early age, but that does not mean that they must be forced, especially for children with diabetes mellitus.

"For healthy children, fasting cannot be forced, especially in children with special conditions, including children with diabetes mellitus," he said.

In children with diabetes mellitus, more diabetes mellitus type 1, the child's body cannot produce insulin naturally, so it requires life-long insulin injections. Even so, children with diabetes mellitus can still fast with close monitoring and supervision.

"Various efforts need to be considered so that children with special conditions can still fast safely and comfortably so that they can carry out their fasting well until breaking the fast later," said Piprim.

Citing various sources, diabetes mellitus or better known as diabetes is a chronic disease characterized by high blood sugar levels. This disease occurs when the body cannot produce insulin adequately or does not respond normally to insulin.

Diabetes mellitus can cause fatal health complications such as heart disease, kidney failure, blindness, amputation, and even death. Executive Director of the International Pediatric Association, Professor Aman Pulungan, said that worldwide there are an estimated 12 million children with type 1 diabetes mellitus. In Indonesia itself, based on data from IDAI 2017-2019, there are 1,249 children with type 1 diabetes mellitus.

Patients with diabetes mellitus need to have a good and consistent diet, adequate movement activities (6 thousand to 10 thousand steps per day), adequate sleep, and stress-free.

During fasting, the body does not get food intake for approximately 14 hours so that the body's metabolism will use more energy reserves in the body. In this condition, glucose in the body will decrease so that it is at risk of hypoglycemia, which is the condition when blood sugar levels or glucose are below normal. If blood sugar is very low, this condition can be dangerous for children fasting.

An endocrinological consultant pediatrician at R Saiful Anwar Hospital, Malang, Harjoeji Adji Tjahjono, said children and adolescents with diabetes mellitus can still fast.

However, fasting must be done by paying attention to several things, including controlling metabolism and being under the supervision of the diabetes team or medical personnel.

"Children and adolescents with diabetes mellitus can perform fasting on condition that their metabolic control must be good," said Harjoedi, who is also a member of the IDAI endocrinology coordination work unit (UKK) in a webinar held in Jakarta, Tuesday (4/4/2025).

A study from the International Society for Pediatric and Adolescent Diabetes (ISPAD) states that about 30-40 percent of diabetics fasting risk hypoglycemia, especially if their blood sugar levels are unstable.

Danger signs will appear if blood sugar levels are less than 70 milligrams per deciliter. At school age, ideal blood sugar levels range from 80-120 mg/dL while fasting and 80-160 mg/dL two hours after eating.

That is why, said Harjoedi, blood sugar monitoring must be carried out regularly and periodically. Examination can be done at least before breaking the fast, before dawn, at noon before the midday, and whenever hypoglycemia signs appear.

"It is important to note to cancel fasting if blood sugar is less than 70 milligrams per deciliter or more than 300 milligrams per deciliter or more than 250 mg/dL with positive blood tons. Risks can occur so that it needs regular glucose monitoring," said Harjoedi.

In addition to regular blood sugar monitoring, proper insulin and food selection during sahur and breaking the fast also need to be considered so that children's fasting can run safely and smoothly.

Eating large amounts of carborated food should be avoided when breaking the fast. Meanwhile, when suhoor, you should choose foods that contain complex carbohydrates.

Foods containing complex carbohydrates are slower to digest the body and relatively do not cause a jump in blood sugar. Also make sure the foods consumed are balanced, namely containing vegetables, animal and vegetable protein, complex carbohydrates, and fruits.

When breaking the fast, avoid too sweet foods. Choose foods with natural sugar content, such as fruits, fruit juice, or dates. Distribution of the portion of eating during fasting also needs to be regulated properly.