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‘There was no time to sleep’: 4 Jews reflect on a year of helping Ukrainians at war

(JTA) — In the months after Russian tanks rolled into her country last February, the music largely stopped for Elizaveta Sherstuk.

The founder of a Jewish choral ensemble called Aviv in her hometown of Sumy, in the northeastern flank of Ukraine, Sherstuk had to put singing aside in favor of her day job and personal mission: delivering aid to Jews in Sumy.

“There was no time to sleep,” Sherstuk recalled to the Jewish Telegraphic Agency recently. “All my team members worked the same, 24/7.”

A year later, Sherstuk is still hustling as the Sumy director of Hesed, a network of welfare centers serving needy Jews in the former Soviet bloc. But she has also begun teaching music classes again, too — with performances sometimes held in bomb shelters.

Catch up on all of JTA’s Ukraine war coverage from the last year here.

Sherstuk’s story reflects the ways that Russia’s war on Ukraine has affected Jews in Ukraine and beyond. The conflict has killed hundreds of thousands, left even more in peril and fundamentally altered the landscape and population of Ukraine, forcing millions to flee as refugees.

But the war has also mobilized the networks of Jewish aid and welfare groups across Europe, leading to a Jewish organizational response on a massive scale not seen in decades. And Ukrainian Jews who have remained in the country have recalibrated their lives and communities for wartime.

Here are four stories about Jews who stepped in and stepped up to help, and a taste of the on-the-ground situations they found themselves in.

‘I was needed there’

Enrique Ginzburg, second from right, is shown with Ukrainian doctors in Lviv. (Courtesy of Ginzburg)

Since nearly drowning at 23, Dr. Enrique Ginzburg has felt he “had to pay back” for the extra years of life he was granted.

Now 65, the professor of surgery at the University of Miami’s Miller School of Medicine and its trauma division has lent his critical care expertise in Haiti, Argentina, Kurdistan and Iraq, in various emergency situations. But until last year, he had never been to a war zone.

The Cuba native felt drawn to Ukraine because his grandfather is from Kyiv, while his grandmother is from nearby eastern Poland. So early on in the conflict, he called Dr. Aaron Epstein, an old friend and the founder of the nonprofit Global Surgical and Medical Supply Group.

“Get yourself a flak jacket, a helmet, a gas mask and come on over,” Ginzburg said Epstein told him.

He has been to Ukraine twice under the nonprofit’s auspices, last April and July. Ginzburg’s explanation for why he flew across the world to put himself in danger: “I was needed,” he said.

His base was an emergency hospital in Lviv, a city located west enough that it became a major refugee hub. He consulted with front-line Ukrainian physicians, many of them young and inexperienced, and hospital administrators, watching the doctors in action. He also visited patients in hospital wards and helped to treat gunshot wounds and assorted combat injuries.

Ginzburg’s bags were packed with meaningful supplies. Some had been requested by his Ukrainian colleagues for medical use, mostly specialized catheters. But he also brought tefillin, the phylacteries used by Jews in their morning prayers. Ginzburg, who studied in a yeshiva while young but no longer considers himself Orthodox, wrapped them every day while in Ukraine.

Even though Lviv was far from the fighting, he could hear air raid sirens and the explosion of the Russian missiles, sometimes feeling the earth shake. When intelligence reports warned Ginzburg’s medical team of impending missile attacks, they sought refuge in safe houses.

“Today,” he told the Miami Herald last June, “I was calling my life insurance [company] because I have young sons and my wife, so I’m trying to make sure I have good coverage.”

By the end of his trips, Ginzburg lost count of the number of doctors he helped train and the number of patients he saw. “I’m sure it’s hundreds.” He plans to make a third trip sometime this year.

‘This is our new reality’

Karina Sokolowska is the director of the American Jewish Joint Distribution Committee’s activities in Poland. (Courtesy of the JDC)

As the director of the JDC, or the American Jewish Joint Distribution Committee, in Poland, Karina Sokolowska has heard countless harrowing stories over the past year. But one sticks out in her memory.

It involved an elderly Ukrainian couple she met at the Poland-Ukraine border in late spring. The husband was in a wheelchair, and Sokolowska helped push him — back towards Ukraine. They had spent three months in a shelter in Poland but eventually “realized we cannot go looking for jobs, we cannot restart our lives. We are too old,” the woman said.

“If they are to die, they’d rather die back home,” Sokolowska said. “It’s a story of hopelessness. They are so vulnerable.”

Last year, about 8 million Ukrainian refugees made their way to Poland, the bordering country that accepted the most refugees. Early on in the conflict, Sokolowska contacted and visited Jewish communities throughout Poland, investigating the availability of places where the soon-to-be-homeless refugees could be housed. She also traveled to some of the border crossings where the Ukrainians entered, to arrange transportation to venues in Poland and to oversee the conditions in which the refugees would begin their new lives.

Later she would help with, among other things: arranging legal advice for the people who arrived with few identification documents; lining up medical care and drugs; finding them short- and long-term housing; connecting them to psychological counseling; providing kosher meals; and even caring for the refugees’ pets (“dogs and cats with no documents”).

According to JDC statistics, the organization “provided essential supplies and care” to 43,000 Jews in Ukraine and “aided 22,000+ people” there with “winter survival needs … more than double the amount served in previous years.” The welfare organization also claimed to provide “life-saving services” to more than 40,000 refugees in Poland, Moldova, Romania, Hungary, Bulgaria and other European locations. It also helped evacuate about 13,000 Jews from Ukraine. (Israeli Foreign Minister Eli Cohen recently said 15,000 Ukrainian Jews in total have immigrated to Israel since the start of the war.)

Karina Sokolowska, JDC director for Poland and Scandinavia sits in her office down the hall from a hotline room, in early March 2022. (Toby Axelrod)

At the height of the refugee flood, Sokolowska said her monthly JDC budget ballooned to more than what she previously spent in an entire year. Her office went from having a few employees to over 20. The amount of sleep she got decreased in tandem; she started taking sleeping pills to get rest when she could.

“This is our new reality” in Poland, she says of the JDC work with Ukrainian refugees. “This is our life now.”

Sokolowska, the granddaughter of Yiddish-speaking Holocaust survivors, became active in Jewish life during college, when a classmate heard her pronouncing some German words with a Yiddish accent and persuaded her to lead the Polish Union of Jewish Students. As JDC director for Scandinavian countries in addition to Poland, she typically organizes educational conferences and helps Jewish families learn about traditions they had not learned while growing up in the communist era.

Today, her sense of optimism has been ground down.

“Everything changed when war came to Ukraine — there is less hope,” Sokolowska said. “It’s a totally new everything. Every aspect of our life changed. Our hope for this to be over soon is going down, down, down. Nothing will change.”

‘It could [have been] me’

Tom and Darlynn Fellman volunteered in Krakow in October 2022. (Courtesy of Tom Fellman)

Sometime in the late 1890s, Harry Fellman, about 20 years old, left his home in Ukraine. According to family legend, he was a sharpshooter in the Ukrainian army and was about to be sent into active combat. Instead, he emigrated to the United States and settled in Omaha, Nebraska, where he became a peddler.

His grandson Tom Fellman — whose middle name is Harry — doesn’t know all the 120-year-old details, but he knows that he is grateful that Harry Fellman decided to leave Ukraine when he did.

“It could [have been] me, if my grandparents had not left when they did,” said Fellman, a successful real estate developer and philanthropist in Omaha.

In October, at 78 years old, Fellman made the reverse trip across the Atlantic to pitch in to the relief effort. He also wanted to pay what he sees as a debt to the memory of his late grandfather and to help the current generation of Ukrainian Jews.

He and his wife Darlynn served as volunteers for a week at the Krakow Jewish community center, joining hundreds (possibly thousands) of volunteers from overseas who have gone to Poland and the other nations in the region over the last year to participate in humanitarian programs on behalf of the millions of Ukrainian refugees. Fellman worked nine hours a day with a half-dozen fellow foreign volunteers in the basement of the community center, transferring the contents of “big, big” sacks of items like potatoes and sugar into small containers to be distributed to refugees in the building’s first-floor food pantry. His wife spent her time in an art therapy program that was set up for the refugee mothers and children to raise their spirits.

Fellman is “not particularly religious” but supports “anything Jewish.” In 1986, he accompanied a rescue mission plane of Soviet Jews headed to Israel. “It was the most rewarding experience of my life,” he recalled.

Fellman says he plans to return to Poland, in June, for the JCC’s annual fundraising bike ride from Auschwitz to Krakow.

What did his friends think of his septuagenarian volunteer stint? “They thought it was cool,” he said. “But none of them are going too.”

‘Everything was a risk’

Elizaveta Sherstuk runs a branch of Hesed, a network of welfare centers, in Sumy, Ukraine. (Courtesy of Sherstuk)

Sherstuk’s parents would have sent their daughter to a Jewish school in her early years if they had had the option. But Jewish education was not permitted In Sumy during the final years of communist rule in the Soviet republic. Sherstuk was exposed to Jewish life only at home.

Her parents infused her with a Jewish identity, she said, and her grandparents used to talk and sing songs in Yiddish. That inspired Sherstuk’s first career as a singer and a music teacher, during which she founded Aviv and took it on tour throughout the region singing traditional Jewish songs. Later, she became the director of Sumy’s branch of the JDC-funded Hesed network.

Sumy, an industrial city with a population of 300,000 before the war situated only 30 miles from the Russian border, was one of Russia’s first targets. In the days before the pending invasion, Sherstuk stockpiled food, which was certain to become scarce in case of war, and arranged bus transportation to safer parts of the country for hundreds of vulnerable civilians, mostly the elderly and disabled. The bus plan fell through for safety issues.

As the bombing started, it became dangerous for members of the local 1,000-member Jewish community, many of them elderly, to venture outside of their apartments. Sherstuk, working out of a bomb shelter, assisted by a Hesed network of volunteers, coordinated food and medicine deliveries.

The situation grew more dire, and she coordinated the Jewish community’s participation in a brief humanitarian corridor evacuation of vulnerable civilians that the Russians permitted. She communicated with Sumy residents mostly by smartphones provided by the JDC — the Russian attacks had cut the landlines — and accompanied the busloads of Sumy Jews to western Ukraine. Some of them eventually moved on to Israel, Germany, or other nearby countries, she said.

Sherstuk stayed in western Ukraine for a while (“The humanitarian corridors are only for one-way trips,” she noted), moving from place to place, keeping in touch with the Jews of Sumy and waiting for Ukraine’s army to make the trip back safe. But Sumy, like many Ukrainian cities, has come under frequent Russian rocket attack.

“Everything was a risk,” she said. “We were following whatever our hearts told us to do. We had to save people. I was the one who had to do it.”

Last May, Sherstuk was among 12 men and women (and the sole one from the Diaspora) who lit a torch at the start of Israel’s Independence Day in a government ceremony on Mount Herzl. During two weeks in Israel, she spent some time with members of her family, and held a series of meetings with JDC officials, government ministers and donors. “It was not a vacation,” she said.

After going back to Sumy, at the suggestions of her choral group members and fellow Sumy residents, she organized concerts in Hebrew, Yiddish, Ukrainian and Russian — some in person, some in a bomb shelter in the city’s central square, some online. She has now resumed her music classes, too, and it has all boosted morale. “I [teach] all the time,” she said.


The post ‘There was no time to sleep’: 4 Jews reflect on a year of helping Ukrainians at war appeared first on Jewish Telegraphic Agency.

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Why NBA Teams Start Defending Before Half Court

Image Source: Infographic by author

An NBA defender who meets a ball handler near the opposite baseline is trying to interfere with the possession before the offense gets organized. The immediate reward need not be a steal. Making a guard change direction, protect the ball, or find another receiver can interrupt the route into a play. But pressure has several possible results, and slowing that first journey does not necessarily slow the whole game.

In Logan Murdock’s November 2025 report on full-court defense, Phoenix Suns guard Jordan Goodwin described his aim: “Try to make them take at least six seconds off the clock.” That was his target, not a measured average. Indiana Pacers coach Rick Carlisle described another purpose: getting opponents to play faster than they prefer. Both approaches interfere with timing, though one delays the setup while the other hurries decisions.

The shot clock helps explain the difference. In a normal NBA possession following a made basket, the offense has 24 seconds, with the countdown starting when the inbound pass is legally touched on the court. It must also advance out of the backcourt within eight seconds. Crossing half court does not start a fresh shot clock. Time spent getting there leaves less time to create a shot. A defensive deflection that stays inbounds does not restart the countdown.

Defensive pressure also needs careful interpretation in basketball betting. An NBA matchup on the Bovada website cannot be reduced to whether one team presses: the combined score depends on how often both sides get the ball and what they do with their chances. A defender delaying the first pass into an offense can leave less time for a good attempt. A turnover followed by a quick basket has a different effect.

Those possibilities make defensive intensity an incomplete description of a scoring outlook. A team can force its opponent to work harder while creating quick attacking chances for itself. It can also concede an easy chance when pressure fails. Understanding the tactic means separating its purpose from its outcome, rather than treating an aggressive defender as evidence that the game must produce fewer points.

Pressure does not always mean a trap

One defender following the ball is different from two defenders closing around it. The first can contest the dribbler while teammates remain with their own assignments. A trap commits another player to the ball, so teammates elsewhere must cover the passing options and protect the basket.

A stopped dribble changes the contest. Once a player voluntarily picks up the ball, he cannot simply start dribbling again. He can still pivot, pass, or shoot, but moving away from pressure with another dribble is no longer an option. A defender can therefore restrict movement without taking possession. This is also why a guard’s choice to keep the dribble alive deserves attention: it preserves a way to move while searching for a pass.

Watch where the ball goes next. A trap can succeed by forcing an awkward pass that another defender intercepts. The players surrounding the ball do not have to be the ones who take it away. Reaching for a steal also differs from keeping the ball handler contained; abandoning position can give the guard a route past the pressure.

The offense has answers. In the Murdock report referenced earlier, Golden State guard Brandin Podziemski described using his body to shield the ball against smaller defenders and quickness to get beyond longer opponents. Beating the first defender can leave that player trailing, creating a temporary advantage farther upcourt. The remaining defenders then have to respond to an attack before their teammate has time to recover.

Three possible outcomes of early pressure: delayed setup, hurried decisions, or an attacking advantage when pressure is beaten

The work before a highlight

Former NBA guard Keith Bogans gives a defender’s perspective in his conversation with Vernon Maxwell. Discussing Jaden McDaniels, Bogans says that seeing a defender pick up a superstar across the court gets him excited in the way a dunk or crossover excites other viewers.

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His reaction focuses on the challenge being accepted. The scorer has someone to deal with before reaching a preferred attacking position. Bogans also describes the recognition that such defensive work receives from teammates and coaches, even when it attracts little attention elsewhere.

The assignment does not end when the scorer passes. The defender still needs to follow the play and be ready for the ball to return. Early pressure can force a star to give up the ball without removing him from the possession. Watching the next pass shows whether the defense has actually disrupted the attack or merely moved it.

When defense creates offense

Indiana scored 19 points off turnovers in Finals Game 6 against Oklahoma City on June 19, 2025. The figure does not isolate full-court pressure.

A change of possession ends one team’s opportunity and begins another’s. The team winning the ball can attack immediately or organize its offense, depending on the space and defenders ahead. Pressure therefore cannot be assessed only by the time an opponent spends bringing the ball forward.

Look beyond the pickup point. Does the offense arrive late but still organized? Does it make a hurried pass? Does the ball handler escape and make the remaining defenders cover extra ground? The first defender can use up time without winning the ball. If the guard gets past him, watch whether the other defenders can stop the drive without leaving someone open.

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In ex-Knick Michael Sweetney, Jewish friends mourn a beloved coach ‘who knew exactly how to show up’

Tamir Goodman stuck out like a sore thumb, a yarmulke-wearing redhead at a practice for a showcase of Greater Washington’s top high school talent. The year was 2000, and Goodman, an Orthodox Jewish hoops prodigy, had already been on the cover of Sports Illustrated. What he did not have at that practice was a friend.

But when the all-star team’s coach had players pair up for shooting practice, one teammate approached Goodman: the 6-foot-8, Georgetown-bound power forward Michael Sweetney.

“He’s like, “Hey, I’ll be your shooting partner,” Goodman, 44, recalled by phone Thursday. “And from that moment, we just never left each other.”

Sweetney, who went on to play for the New York Knicks, later said he had never met a Jewish person before that day. But when he died Wednesday of complications from a heart attack, he had not only one Jewish friend mourning his passing, but hundreds.

Mike Sweetney, left, with Tamir Goodman on a trip to Israel in 2019. Courtesy of Tamir Goodman

Orthodox Jewish New Yorkers, who got to know Sweetney through his years teaching basketball at their schools, summer camps, synagogues and even birthday parties, remembered him in tributes Thursday as a humble mentor, a model of courage and a loyal friend in times of Jewish vulnerability.

Those early shooting sessions with Goodman, it turned out, had planted the seed for Sweetney’s post-NBA basketball endeavors, including a four-year stint at Yeshiva University, where he served as an assistant during the men’s team’s famous 50-game win streak.

“The world lost a giant today,” Elliot Steinmetz, Yeshiva’s head coach, wrote Thursday on X. “I lost a close friend. The basketball world lost a beloved star. Our Jewish community lost an ally and someone who knew exactly how to show up.”

Sweetney, who was 43, is survived by his wife, India, and three children.

A perfect matchup

Sweetney brought undeniable but understated starpower to the basketball-obsessed Orthodox community. That community’s embrace also helped Sweetney find purpose after his playing career and reignite his love for the game.

After starring at Georgetown, Sweetney was selected ninth by the Knicks in the 2003 NBA Draft — eight picks after LeBron James. But Sweetney’s career in the league lasted just four years, derailed by struggles with weight and depression that followed his father’s sudden death. (He later revealed he had contemplated suicide as a rookie.) He played another decade for pro teams in China and Latin America before washing out of the sport.

Sensing that his friend was in a bad place, Goodman invited Sweetney to Israel in 2019 to help with a basketball camp he had started.

“I told him a lot of good things happen when you come to Israel,” Goodman said. During the visit, Sweetney opened up about the challenges he had been experiencing. Goodman suggested he go into coaching, and soon connected him with Steinmetz — a Knicks die-hard — who offered him a job.

“When Tamir called me about him, initially, I’m like, ‘Oh, cool, I get to talk to Mike Sweetney, that’ll be fun,’” Steinmetz said Thursday in an interview. “Once I spoke to him the first time, I’m like, ‘That’s just such a nice guy.”

A Yeshiva League staple

Sweetney’s entry into the world of Orthodox Jewish basketball, initiated by Goodman, helped facilitate his turnaround, transforming a point of professional failure into a source of inspiration for others.

A classic back-to-the-basket player in his day, Sweetney relished working with the Yeshiva forwards, who delighted in trying their post moves on a former NBA lottery pick.

“All the bigs’ favorite part of practice was going up against Mike,” recalled Gabriel Leifer, a team captain during Yeshiva’s win streak.

Sweetney was getting something out of the work, too. Those who worked with him up close could see his passion for the sport — which had become a dark place for him — coming back to life.

Sweetney signs autographs on Yeshiva’s home court. Courtesy of Elliot Steinmetz

Harold Katz, a coach who occasionally helped with the Yeshiva program, said that despite his NBA pedigree, Sweetney had no pretenses when it came to learning the school’s motion offense. Instead, he seemed to enjoy it. “He would always say it’s fun — like playing this way is fun.” Katz remembered. “He’d say, ‘I wish I played in this.’”

Sweetney told the New York Post in 2019 that the Jewish world had helped him find stability after basketball.

“I’m comfortable here. I’m treated well here. It’s been amazing,” he said at the time. “To be happy and be at peace, I would’ve been shocked. I wouldn’t have thought it was possible.”

The coaching roles — at Yeshiva and at Ramaz, an Orthodox high school where he coached the girls’ team — also helped Sweetney book speaking engagements and countless youth basketball clinics. He also became an advocate for Black-Jewish relations.

“It starts off that, ‘Oh my God, there’s this big NBA guy who’s at all the YU games,’” Steinmetz said, “but then people start talking to him and they fall in love with his personality because he’s just such a warm, caring guy.”

Driving to and from Yeshiva games over the years, Steinmetz and Sweetney grew close — a friendship that held even after the latter left Yeshiva in 2023 to work in the mental health arena.

The true testament to the kind of person Sweetney was, Steinmetz said, came after they stopped working together, on Oct. 7, 2023. Steinmetz was in Israel at the time; the first text message he received as the attacks were unfolding, he said, was from Sweetney.

“He’s like, ‘Please confirm for me that you’re okay,’” Steinmetz said. “Two days later: ‘Hey, did you get home yet?’ He just cared. He wasn’t checking a box — he cared.”

If you are in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

The post In ex-Knick Michael Sweetney, Jewish friends mourn a beloved coach ‘who knew exactly how to show up’ appeared first on The Forward.

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Sacred fasting meets Ozempic

Millions of people worldwide – as many as 1 in 8 adults in the U.S. – are on GLP-1 medication, such as Ozempic, Mounjaro, Wegovy and Zepbound, for treating diabetes or for weight loss.

These drugs are adding a medical twist to religious observances that involve fasting, such as the Jewish holiday of Yom Kippur, which will be observed from sundown on Sunday until nightfall on Monday. Traditionally, fasting on Yom Kippur means forgoing food and water for about 25 hours, which can strongly affect a person’s metabolism.

Other religious traditions include different types of fasts. For example, Muslims who fast during Ramadan neither eat nor drink from dawn to sunset, but they break their fast each night. Christian and Hindu traditions also include dry fasts as well as partial fasts, such as Lent and Navratri, in which people avoid certain foods.

As a specialist in obesity medicine, I work with many patients who take GLP-1 drugs. Most people can safely fast for Yom Kippur or other religious or cultural observances. But depending on their circumstances, they may need to plan ahead, take certain precautions and be clear on when it’s medically advised that they break their fast.

Common GLP-1 side effects and fasting

GLP-1 drugs such as Ozempic, Mounjaro, Wegovy and Zepbound mimic a natural gut hormone– glucagon-like peptide 1 – that lowers your blood sugar by triggering insulin release when your blood sugar is high. These drugs also slow how quickly food passes through the stomach, which reduces appetite to aid in weight loss.

GLP-1s have some common side effects that can occur in anyone taking them, including nausea, vomiting, dizziness, constipation and dehydration. Fasting may exacerbate them, especially in people who are prone to an upset stomach. GLP-1 side effects are also more common when a patient is increasing their dose, which usually happens monthly as tolerated until they reach their full dosage.

That’s why, if you’re planning to fast for Yom Kippur, it’s best to avoid starting a new GLP-1 medication or increasing the dose of your medication sooner than two weeks or so before the holiday.

GLP-1 drugs work by simulating a gut hormone produced in the body, spurring the release of insulin and slowing down digestion.

Timing your dose

If you take GLP-1 drugs as weekly injections, which is the most common way of dosing these medications, you should stick to your schedule even if you plan to fast. These drugs stay in your system during the entire week, so moving or skipping that weekly dose right before fasting can interfere with their effects on blood sugar or weight loss.

If your weekly injection falls on Yom Kippur, you can generally go ahead and administer it as scheduled. Some patients do report increased nausea on their injection day – if that happens to you, you may wish to delay the injection until after the fast, if you’ve cleared it with your doctor.

Patients who inject GLP-1 drugs daily may need to adjust the timing. For patients taking these medications for diabetes treatment, it may make sense to do the injection right before the meal that breaks the fast or to hold off until after the fast. This helps reduce the risk of stomach side effects, which can occur when these medications are taken on an empty stomach.

More recently, many patients have switched to oral GLP-1 medications. These pills must generally be taken on an empty stomach with a small amount of water, at a set time before taking any other drugs or any food or beverages.

Because fasting for Yom Kippur includes abstaining from drinking, taking the pill as directed may involve breaking the fast. That means you’ll need to decide in advance whether to take the medicine before the fast begins, after the fast ends or on an alternative schedule. It’s best to avoid simply skipping the daily dose scheduled for Yom Kippur and taking a double dose after the fast.

Skipping the dose won’t be harmful if you’re taking the medication for weight loss. But if you have diabetes, skipping it could dangerously elevate your blood sugar. And doubling the dose later could lead to serious side effects, such as pancreatitis, an inflammation of the pancreas that can lead to hospitalization.

Diabetes versus weight loss

If you’re using GLP-1 medications solely for weight management, fasting for 25 hours should not pose serious issues beyond stomach upset. In rare cases, though, combining these drugs with fasting can stress the pancreas enough to cause pancreatitis.

Fasting on GLP-1s carries the biggest risks for diabetic patients. That’s because GLP-1 medications are often used alongside other drugs that work primarily by lowering blood sugar, which raises patients’ overall risk of a blood sugar crash.

The greatest concern is in patients taking a GLP-1 medication together with insulin or drugs that stimulate insulin production, such as sulfonylureas. The GLP-1 medication itself may not cause a drop in blood sugar. But because it suppresses appetite and lowers glucose levels, these other medications can magnify the risk of low blood sugar during a prolonged fast.

If that’s your situation, talk to your doctor about whether you can adjust the timing, dose and type of insulin you take and reduce your dose of sulfonylurea in order to fast safely.

In general, people who have Type 1 diabetes or poorly controlled diabetes are strongly advised not to fast – as are people who:

  • Experience frequent or severe drops in blood sugar.
  • Have hypoglycemia unawareness – an absence of warning signs for high blood sugar.
  • Are managing diabetes during pregnancy.
  • Have severe kidney disease with a high risk of dehydration.
  • Experience severe gastrointestinal side effects from GLP-1 medications.
Not overeating along with drinking plenty of water beforehand is helpful for anyone fasting – but crucial for people on GLP-1 medications.

From prefast prep to the post-holiday meal

Regardless of what GLP-1 medication you take and for what indication, if you plan to fast you’ll need to do some pregaming, monitor how your fast is going and be mindful of how you break it.

  • First, if you are unsure about anything, talk to the clinician who is monitoring your GLP-1 drug treatment so you can decide together whether fasting is safe for you and whether your situation requires any special precautions.
  • Before fasting, it’s important to eat a normal meal that includes protein and to avoid both overeating and undereating. Overeating is never recommended when on GLP-1 medications, and undereating can set you up for more side effects during the fast. Although GLP-1 therapy can substantially reduce appetite, patients should avoid skipping the prefast meal entirely.
  • GLP-1 medications don’t just decrease appetite – they can also suppress the body’s natural thirst signals. So before your fast begins, aim to stay hydrated to prevent getting dehydrated while fasting.
  • If you are diabetic, make sure you fast under close guidance from your doctor – and make sure you are checking your blood sugar during fasting. Using a glucose monitor is a good idea, particularly if you are taking insulin or other glucose-lowering medications. The goal is for your blood sugar to remain within your usual daily nonfasting range.
  • Be ready to break your fast right away if you start feeling dizzy, confused, faint, nauseated or acutely ill, or if your blood sugar dips too low or spikes too high. These symptoms are dangerous and need to be addressed immediately. Stash a rapid source of carbohydrates – even just some glucose tablets or a few hard candies – within reach so you can access them quickly if needed.
  • Finally, plan a gentle, balanced meal to break the fast rather than an unusually large meal, which may provoke nausea, abdominal pain, reflux or vomiting. It’s generally best to avoid higher-fat foods, too, since they can slow down digestion.The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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