For members of any religion, holidays are usually a joyous time for family, faith, and feasts. For people with diabetes like myself, those feasts are just as enticing as they are for anyone else—but they can come with a higher price tag.
In fact, as an observer of the Jewish Sabbath, I encounter the challenge of festive eating on a weekly basis. Typically, the Friday night and Saturday afternoon Sabbath meals involve a blessing over grape juice (high sugar content); another blessing over the Jewish tradition’s “challah” bread (high carbohydrate content—think a soft and smushy bagel); a fish appetizer; salad; a main course spread that can include chicken and/or red meat, vegetable side dishes, starchy side dishes, and grains; and dessert. It’s a smorgasbord that would throw any person with diabetes for a loop, whether you take a fixed or variable dose of insulin or oral medication.
Jewish holidays such as Rosh Hashanah, the Jewish New Year, consist of two consecutive days of Sabbath-style laws and traditions—so double the festive meals. Some years, the two-day holidays fall on Thursday and Friday, meaning three consecutive days of festive meals because the usual weekly Sabbath directly follows the holiday.
As (presumably) a Type 2 diabetic from age 21 to 25, I transitioned from oral medication to twice-daily fixed doses of 70/30 mixed insulin, meaning the insulin contains both short-acting and intermediate-acting components. On a fixed dose of insulin, massive Sabbath and holiday meals were especially difficult because I was eating two or three times the amount I normally would eat at a single meal, yet taking the same amount of medication. You can imagine the blood sugar readings on my glucose meter—easily into the 200s and 300s a few hours after mealtime, a far cry from the preferred range of 80-120.
Why didn’t I turn down the extra food? As people with diabetes know well, the condition changes our biology, but not necessarily our temptations and habits. If enticing food is sitting in front of me—especially for the entire duration of an hours-long festive holiday meal—I’ll most likely eat it even if I know it’s bad for my health. I want to be “normal” and eat what I want. Blood sugar be damned! It’s a temporary state of denial about my condition. The glucose meter reading brings me back down to earth a few hours later.
At age 25, when mixed insulin stopped working for me wholesale, I was re-diagnosed as a person with Type 1 diabetes. I was previously insulin-resistant, but I was now producing no insulin at all. I started taking two forms of insulin, short-acting and long-acting, with variable doses of short-acting before each meal based on the carbohydrate content of what I planned to eat, then a fixed dose of long-acting nightly to act as a 24-hour base.
The transition to this new medication strategy was incredibly empowering because it put me in control. I knew that while healthy eating was still a priority, I could have more flexibility in my diet through precise counting of carbohydrates paired with the corresponding dose of insulin. I got my blood sugar under control for the first time in several years.
But for Sabbath and holidays, carb counting is a dangerous game. If I’m eating double or triple the amount of carbs, do I take double or triple the amount of insulin? Where do I draw the line? From my experience, carb-heavy eating ultimately can’t be masked by carb counting. The truth comes out, so to speak. The high blood sugar numbers persisted after festive meals, even though I thought I was correctly counting that massive amount of carbs.
High blood sugar isn’t the only challenge of what is known as the Jewish “High Holy Day” period—Rosh Hashanah and Yom Kippur, the latter of which is Judaism’s day of atonement. Coming ten days after Rosh Hashanah, Yom Kippur entails a 25-hour fast. Some Jews who have medically related doubts about fasting will ask their doctor for advice, and others will ask their rabbi. Some rabbis will tell you to ask your doctor. Some doctors will advise people with diabetes against fasting for a whole day due to the danger of low blood sugar, while others will recommend at least trying to fast and then eating in the event of dangerous lows.
When I was re-diagnosed with Type 1 diabetes, I was advised not to fast, even on Yom Kippur—the holiest day on the Jewish calendar. The short-acting insulin at mealtimes wasn’t the concern if I wasn’t eating. Instead, the problem was the fixed dose of long-acting insulin I took each night, which might lead to blood sugar lows if I didn’t eat all day. After a few years, however, my new endocrinologist in Houston said that I could give fasting a try and just be careful about it. Ever since I haven’t run into any major problems with lows on Yom Kippur. Nevertheless, I choose not to take the risk of fasting with some other fast days on the Jewish calendar, because the other fasts aren’t considered as religiously significant.
Of course, my Jewishly relevant diabetes conundrums aren’t unique. It’s a challenge across faiths. Christian diabetics have their potential highs for Christmas Dinner and lows for Good Friday fasting. I can’t even imagine the complications for Muslim diabetics during an entire month of daytime fasting during Ramadan. So how can religiously observant diabetics cope?
For me, mixing religion and diabetes is simply a matter of priorities. After feeling a spiritual and communal void following years of not fasting on Yom Kippur, I tried it again and made fasting work for me in the context of diabetes. It has meant frequent blood sugar checks throughout the fast day, but let’s face it, that’s a good practice for a person with diabetes on any day.
For festive holiday meals, spending time with family is a priority for me, and so is enjoying tasty (and sometimes carb-rich) food—so I’m not about to skip the meals or ignore the food. This has meant developing new strategies such as taking one dose of insulin before the main course and another dose before dessert. The carb counting remains an inexact science, but I can at least indulge while equipped with a thoughtful plan.
So to people with diabetes of all religions, my message is just to have a little faith—the highs and lows of the holidays can be managed.
Jacob Kamaras is a journalist living in Houston.