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September 2, 2020

The High Holidays are a wonderful time of year, but can be challenging to people with diabetes. Here are some tips to help you have a healthy and safe year

Healthier meals

  • Sweet challah, a kind of bread, with raisins is traditionally eaten. If you’re buying, many bakeries also have whole wheat or spelt flour, which affect blood sugar more slowly than white flour. If you’re baking, try substituting flours.
  • Many families do kiddush, blessing “the fruit of the vine” (wine or grape juice) before the meal. Avoid grape juice, especially in large amounts, since it has a lot of sugar. Try using wine, or watering down grape juice. Remember to be moderate with alcohol if you do have something – no more than 2 servings. Alcohol can bring your BG down several hours later (hypoglycemia), so make sure to eat carbohydrates at the meal.
  • Be careful of your portion sizes. Try using the plate method (1/4 plate carb, ¼ plate protein, ½ plate veg). Try to limit how much honey you put on apples and challah.
  • While apples and honey are the most famous, there are many other foods traditionally eaten on Rosh Hashana that are less sweet and do not have as big an impact on your blood sugar. Try using them in addition to apples and honey, or base recipes on them. Different parts of the Jewish world have different traditional foods. This can be a good opportunity to ask older relatives what they ate for Rosh Hashana meals growing up, and to create new traditions with your children and grandchildren.

o   Squash, leeks, fenugreek, beets and dates are mentioned in the Talmud (Horayot 12a) to symbolise prosperity because they grow abundantly.  (The Talmud is a collection of discussions of Jewish law, philosophy and history, and was finalized in the 5th century).

o   Ashkenazi Jews (Eastern European) traditionally eat carrots because the Yiddish word for carrots, “mehren”, also means to multiply and we want our good deeds to multiply.(Yiddish is the language traditionally spoken by Eastern European Jews).

o   Many have the tradition to eat a fruit that they haven’t eaten this year, to make the day extra special. Some fruits that are have a lower glycemic index and will hence raise blood sugars more slowly include berries, melons, and apricots. Choose fruit portions of about 1 cup or your fist size closed. Special fruits also make a nice dessert idea.

o   Pomegranates are traditionally eaten to represent that our good deeds should be as numerous as the seeds of a pomegranate.

o   Fish is traditionally eaten in a lot of families, to symbolise fertility. Store-bought gefilte fish is often high in sugar and salt, so try buying a lower-salt version, try a different fish recipe, or even make your own gefilte fish! (Gefilte fish is a traditional recipe of fish ground with spices and boiled. It is specific to Ashkenazi Jews).

  • Have a snack in the afternoon before the meal. This can help if the meal is eaten late, as some diabetes medications can make the sugar go too low if a meal is delayed. It can also help prevent you from overeating since you won’t be as hungry. Try having something with protein, like cheese, nuts, yogurt, or veggies with hummus. Make sure to eat carbohydrates as well, like fruit or crackers.
  • A change in routine can affect your blood sugars, especially with certain medications. You may want to monitor them more frequently. Speak with your diabetes care team about how often to test.
  • Drink plenty of sugar-free fluids during the meal. This includes water, diet pop, and seltzer. Alcohol can affect your sugars and dehydrate you, so be sure to also include non-alcoholic beverages.
  • Go for a walk after supper to help stabilize your blood sugars. Bring your family with you. Start a new tradition.
  • If feasible, host the meal yourself. That gives you the most control over the menu. You can also offer to bring something.
  • Don’t stress afterwards if you overate. Just try your best and move on.

In the synagogue

  • Services are long, meals may be delayed, and you will be spending most of your time sitting. A change in routine may alter your blood sugars, especially if you take insulin or certain other diabetes medications. You may want to check them more frequently. Speak with your diabetes team or pharmacist if you have any concerns.
  • Bring rapid-acting sugar to treat hypoglycemia, and snacks to prevent it. Good ideas for snacks include cheese or hummus and crackers, or nuts and fresh or dried fruit. These should be easily accessible. Try keeping them in a bag by your seat or with your coat.
  • If you are uncomfortable eating or checking your blood sugar in public, identify a private place to do so. Options include the cloakroom, an empty classroom, outside, or an unused office. You may want to try to reserve a seat closer to an exit door. (In many synagogues, so many people come to services on Rosh Hashana that seats are reserved in advance).
  • Take breaks during the service to go for a short walk. If you’re not comfortable doing that, alternate between sitting and standing during the service.
  • Go for a walk in the afternoon after lunch. Bring your family too, to make it a family affair. Go admire the fall leaves, or walk to a river to do Tashlich (the traditional ceremony that represents casting away sins by throwing breadcrumbs into a body of water).

Preparing to fast on Yom Kippur (type 2 diabetes).

  • Speak with your health care team to determine if it’s safe for you to fast. People with diabetes for whom it is not recommended to fast include people with heart or kidney disease, uncontrolled blood sugar, hypoglycemia unawareness or frequent episodes of hypoglycemia, a recent hospitalization for diabetes, recent illness or surgery, frail elderly people, pregnant or nursing women, or people who have had significant trouble fasting in the past.
  • If you are told it’s not safe to fast, concentrate on the other parts of Yom Kippur – repentance, the special prayers and Torah (Bible) readings, not wearing leather shoes, not bathing, avoiding physical intimacy, and wearing white to represent purity. Fasting if your health care team tells you it’s not safe to do so is breaking Jewish law.

o   If you’re not fasting, helping friends and family who are fasting may add meaning to the day. Do you have friends who are fasting but have young, rambunctious children?               You may consider babysitting for a few hours. Or, offer to volunteer during the service or at the door to give someone else a break. (Many synagogues have members volunteering during the day to check seating, control traffic at the door, arrange participation in the service, etc).

  • If you take pills for your diabetes, you should skip them the day of the fast. Speak with your diabetes team or pharmacist for more information. Take any daytime pills the day before, but skip any pills you take at bedtime. Do not take your diabetes pills while you are fasting – it’s ok if your blood sugar is high for one day. If you normally take pills with supper or at bedtime, you can safely take them once you start eating again. Speak with your diabetes care team or pharmacy to determine what meds need to be adjusted or skipped. Some other medications should be skipped as well on the day of the fast, including some blood pressure medications. Speak with your diabetes team for more information.
  • If you take insulin, the dose will need to be adjusted. Generally, you will skip meal-time insulin if you are not eating, and reduce the dose of once-daily insulin. Speak with your care team to determine a personalized plan.
  1.         The day before the fast, make sure to drink plenty so that your urine remains a light yellow. That shows that you are hydrated.
  2.         Eat a moderate meal before the fast, including protein and fibre to help you feel fuller for longer.
  3.         The guidelines about reducing medications are the same as if you were ill and could not eat or drink due to vomiting. They are called the “sick day guidelines”.

The day of the fast

  • If you take insulin or are prone to low blood sugars, you will need to monitor your blood sugar more frequently. Bring your meter, lancets and extra test strips to the synagogue.
  • Keep any equipment, dextrose tablets, and food with you, if possible in a bag at your seat.
  • Identify a private place where you can go to check your blood sugar and ketones, and eat or drink if you have to. Try an unused classroom or office.
  • Bring treatment for hypoglycemia – fast acting glucose, a snack of carbohydrates and protein, and fluids (sugared to raise your blood sugar, and sugar-free to rehydrate you). If you have been prescribed glucagon, take it with you. (Glucagon is a medication that rapidly raises blood sugar in an emergency, and is sometimes prescribed for people taking insulin).
  • A buddy  at the synagogue with you needs to be aware that you have diabetes and are attempting fasting, and be able to recognize the signs and symptoms of low blood sugar (dizziness, headaches, difficulty concentrating, trembling, sweating, feeling faint). This person can take you to a quiet place and remind you to break your fast if you feel unwell, or assist you if you become very hypoglycemic. If you take a nap on the afternoon of Yom Kippur, have someone check on you.
  • If you develop hypoglycemia (blood sugar less than 4 mmol/L), or if you have symptoms of hypoglycemia (shaking, sweating, trembling, headache, dizziness, trouble concentrating) you must break your fast. If you’re not sure if the symptoms are because of hunger/thirst or because of hypoglycemia and you’re unable to check your blood sugar, it is safer to break the fast. Eat rapid-acting carbohydrates (sugar, honey, glucose tablets, candy) to bring your blood sugar back to target, then eat a protein and a carbohydrate to keep it there. Do not continue to fast. Eat and drink as you normally would.
  • Be psychologically prepared to break your fast early if necessary. This is an issue of pikuach nefesh – saving a life.

After the fast

  • Be sure to rehydrate! Drink plenty of sugar-fluids. Sugar-free popsicles and sugar-free jello count as fluids.
  • Have some protein and a moderate amount of carbohydrates. Having a large amount of carbohydrates, like lots of cake, right after the fast and raise your blood sugar a lot and keep it high for many hours! Leftovers from the night before can be a good choice. Other good choices involve beans or lentils, milk, veggies, rice, cheese or a slice of whole-wheat bread.
  • Eat slowly – your stomach will feel funny after a fast. Don’t eat so fast that you throw it all up.
  • Try to prepare your break-fast meal the day before, so that you don’t just grab the easiest thing.
  • Some synagogues will offer snacks at the end of Yom Kippur so people can eat a little before they go home. Avoid too much cakes and cookies, and try for crackers and egg or tuna salad. It might be helpful to bring food with you, or go straight home and eat.

L’Shana tovah umetukah – have a good and sweet new year!

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