Observing Ramadan with diabetes
The holy month of Ramadan, which sees Muslims all over the world fast during daylight hours, has begun.
Does having type 2 diabetes exclude a person from fasting?
The decision belongs to the person, but getting some advice from health professionals can help.
Type 2 diabetes, which constitutes the majority of diabetes cases, occurs when the body becomes resistant to the actions of insulin, or loses the capacity to produce sufficient insulin from the pancreas. Insulin keeps the body’s blood glucose levels within a healthy range.
People with type 2 diabetes can manage the condition by maintaining a healthy lifestyle, including doing exercise and keeping a healthy diet.
In more serious cases, people with type 2 diabetes may need to take medications such as metformin, sulfonylureas, or other glucose-lowering tablets, or self-administer insulin injections.
Type 2 diabetes affects some ethnicities more than others. It’s more common in people of Middle Eastern, North African and South/Southeast Asian backgrounds.
Dietary practices such as fasting, feasting, and consumption of special foods are an essential component of many religious and cultural celebrations.
During Ramadan, most people have two meals per day, at sunset and before sunrise.
This can be risky for people with type 2 diabetes -- particularly those who use insulin or certain oral diabetes medications -- for a couple of reasons.
First, fasting during the day can increase the risk of low blood glucose levels in people who usually take insulin or other blood glucose-lowering medications.
And conversely, the evening meal to break the fast, called “iftar,” often involves eating large amounts of calorie-rich foods in a relatively short space of time.
This can put people with diabetes at risk of high blood glucose levels overnight. Omission or changes in the timing of medications may also contribute to instability of blood glucose levels.
Low blood glucose levels can cause symptoms of sweating, shakiness, and confusion. If severe, they can lead to seizures, coma, or even death.
High blood glucose levels make people feel tired and generally unwell,and can lead to dehydration and poor concentration.
Extremely high levels are a medical emergency.
According to Islamic teachings, the elderly, pregnant, or those with illnesses requiring regular medication can be exempted from fasting on medical grounds. They do not need to seek special permission from a religious leader.
Certain groups of people with type 2 diabetes who do not use insulin or particular oral medications can safely fast during Ramadan under the guidance of their health care professional. But as diet, lifestyle, and medication are key factors in maintaining stable blood glucose levels and minimizing diabetes complications, many people with type 2 diabetes can also be considered medically exempt from fasting.
The month of Ramadan is a special time for Muslims, where fasting and feasting are integral to religious life, social interaction, and communal celebration.
Because fasting is one of the five pillars of Islam, there is a strong desire to participate, even among those who could be exempt for medical reasons.
Understanding the spiritual significance of this month to Muslims as well as the practical aspects can put health practitioners in a much stronger position to gain patient trust and facilitate communication.
Muslims with diabetes wanting to observe Ramadan should be counselled on the risks of fasting. Drawing on the guidelines, health providers can reassure their patients that those who do not fast for medical reasons also receive spiritual rewards and should not feel guilty.
Health care professionals may suggest donations of food or money to the poor could be considered as an alternative, if it’s within the person’s means.
Doctors might also advise their patient to discuss any concerns with their local religious leader.
For those who choose to fast despite their exemption, discussions about glucose monitoring, nutrition, exercise, and potential medication changes can ensure they fast as safely as possible.
Sue Lynn Lau is Endocrinologist, Western Sydney University. Ahmed Hussein is Endocrinologist and Associate lecturer, Western Sydney University. A version of this article originally appeared in The Conversation UK.