Diabetics? How to Successfully Fast on Yom Kippur

Yom Kippur, one of the most significant days in Judaism, is just around the corner, and it's important to prepare properly. Here are some recommendations on what to include in the pre-fast meal and what to do after the fast to ensure it goes smoothly.

Fasting Wisely - Important Guidelines and Recommendations for Diabetics

Before the fast begins:

• Ensure a positive fluid balance by starting to drink about 2 liters of water the day before the fast.
• For coffee addicts, it is advisable to reduce coffee intake before the fast. Many people suffer from caffeine withdrawal headaches, so it's recommended to gradually accustom the body.
• Include fats and complex carbohydrates in the pre-fast meal. Save vegetables for the end of the meal to avoid early satiety. Don't skip them as the fibers slow sugar absorption and extend the feeling of fullness.
• Avoid excessively large meals, which can make fasting difficult and cause heaviness, fatigue, and heartburn.
• Carbonated drinks can cause gas and discomfort, so they are not recommended. Also, avoid sweetened drinks as they can increase thirst.
• Gas-producing foods like legumes (chickpeas, peas, lentils, white beans) and cabbage, cauliflower, broccoli are not recommended.
• It is advisable to separate liquids from solids by half an hour: drink before or after the meal, not during. This advice also applies to soup; drinking during meals can create a feeling of fullness that might prevent adequate eating or lead to feeling overly full at the end.

During the fast, ensure:

• Monitoring glucose levels, especially for those taking insulin or hypoglycemic medications.
• Reducing long-acting insulin doses by 20% and stopping short-acting insulin and hypoglycemic medications. You can continue taking medications like Metformin, Actos, and Victoza. Stop taking Jardiance due to dehydration risks. Important! Type 1 diabetics should never completely stop insulin to avoid DKA (diabetic ketoacidosis) exacerbated by fluid lack.
• Energy conservation—try to maintain minimal activity levels on Yom Kippur. If feeling weak, it's advisable to lie down with elevated feet. Aim to walk to a nearby synagogue and avoid long walks.
• Preparation for hypoglycemia (blood sugar dropping below 70): inform a relative or friend about the signs and how to assist, and equip yourself with glucose tablets, sugar packets, or a sweet drink.
• If hypoglycemia occurs, the recommendations are:

• Break the fast, drink a glass of juice or take 4 glucose tablets, wait 15 minutes and then retest.
• If blood sugar levels rise, continue fasting but monitor sugar levels frequently.
• If sugar levels remain low, repeat treatment and measure again after 15 minutes.
• For severe hypoglycemia, seek emergency room care.

After breaking the fast:

• Measure your blood sugar levels.
• Drink a warm beverage (not boiling) and eat a slice of cake or bread with jam or honey.
• After half an hour, have a regular meal and continue drinking to replenish lost fluids. Avoid an excessively large meal, as it can overload the digestive system that hasn’t been active for a day. Try to eat slowly and chew well to "help" the digestive system process the food.
• Resume taking medications as usual.

Do Not Fast at All Costs. Situations Where Fasting Is Not Recommended:

• Type 1 diabetes
• Uncontrolled diabetes
• Severe complications of diabetes such as angina
• History of DKA and/or recurrent hypoglycemia
• Gestational diabetes
• Acute infections

It's very important: all these recommendations are for those who have received halachic permission to fast. Diabetics are encouraged to consult a halachic authority to determine whether they should fast or refrain. Consultation is available

For any medical question, it's advisable to consult the treatment team. The DMC Diabetes Center offers online consultations with a doctor without having to go to the clinic.

Have an easy fast and a meaningful Yom Kippur.

Adina Behar is a diabetes and ketogenic dietitian at the DMC Diabetes Center, chair of the Atid Association, and author of "The Ketogenic Diet."