How does a diabetic cope with Ramadan??

Ramadan is one of the foundations of Islam and fasting is an obligation and a duty on every obligated who is able to perform it and because Islam is a religion of ease and mercy and God knows the capabilities of his servants and is keen on their health and their lives has put in place rules to ensure the performance of the obligation without causing harm and peril to the fasting person, Almighty said: “So whoever among you is ill or on a journey [during them] – then an equal number of days [are to be made up].” …. Verse number 184 Al-Baqarah.

There are several health risks that some diabetics may be exposed to if they fast, the most important of which are:

• Severe drop in blood sugar level during fasting.
• Significant rise after Iftar because of unjustified overeating of restricted food.
• Fluid loss and dehydration.
• The occurrence of clots in the arteries.
• All these complications can have serious consequences, including loss of life.

Therefore, it is necessary to make the decision to fast for a diabetic patient with his doctor at least two months before the holy month so that he knows if the patient can fast without expecting harm or not.

If he can fast or insisting on trying to fast, he should learn the following:

• Types, quantities and timings of meals such as delaying Suhoor and drinking plenty of water, avoiding sugars, sweets and fatty foods, eating balanced meals that contain carbohydrates, proteins, fruits and vegetables.
• To be committed to controlling the quality, dose and timing of treatment according to the doctor’s decision and follow-up.
• Check the level of sugar using home device at specific times during and after fasting.
• Know the symptoms and how to treat severe hypoglycemia and interrupt fasting immediately if this happens.
• Trying to fast some days of the month of Sha’ban (the month before Ramadan) to test the ability to fast and ensure appropriate treatment doses.
• The faithful Muslim doctor and the patient must also abide by the fatwa issued by the International Fiqh Council in cooperation with the Islamic Organization for Medical Sciences in its 19th session in the United Arab Emirates on 3/8/2009 and act on it.

The fatwa divided diabetics into 4 categories:

1. Category 1: includes patients with a very high risk of serious complications with certainty:

• Patients with frequent hypoglycemia and elevated blood sugar, which is called fluctuating diabetes.
• The occurrence of cases of acetone diabetic acid?? or diabetic coma in the three months preceding Ramadan
• Patients with loss of sensation with hypoglycemic symptoms.
• Type I diabetics
• Patients engaged in strenuous physical work or in extreme conditions.
• Dialysis patients.
• Pregnant women.
• Those with severe diseases associated with diabetes.

2. Category 2: Patients with relatively high probabilities of complications, which doctors think are likely to occur, such as:

• High sugar levels between 180-300 mg/dL and high cumulative sugar content of more than 10%.
• People with kidney failure.
• People with cardiopathy or encephalopathy… etc
• Those who live alone and are treated with insulin or pancreas‑stimulating pills to produce insulin in large quantities and for long periods of time
  • Those suffering from serious chronic diseases such as cirrhosis and liver failure, weakness of the heart muscle and decline in heart function… Etc.
  • Elderly people suffering from other diseases along with diabetes.
  • Patients taking drugs that affect the mind.

Verdict for categories 1 and 2

It is rightfully obligatory for the patient to break his fast and not fast to avoid harm, and whoever fasts while being harmed sins despite the validity of his fasting.

3. Category 3: Patients with medium probabilities, who have stable conditions, using appropriate treatments that stimulate productive pancreatic cells, such as the family of sulfonyl urea pills, medium or short-term, such as amaryl, dimicron and tophonorm.
4. Category 4: They are those with low probabilities who are treated with diets or treatments that are not expected to lead to a severe drop in sugar, such as Glucophage or that increase the body’s sensitivity to insulin, such as Actos and some new therapeutic groups such as Janofia, Galfas, Angulaisa, Tragenta.

Verdict for categories 3 and 4

Fasting as there is no indication of the possibility of harm, but they may benefit from fasting and the doctor must estimate the quality and dose of treatment according to each case.

May God accepts from us the fasting of Ramadan and its nigh prayers.

Dr. Salah Al-Tijani

Consultant and Head of Internal Medicine Department

United Doctors Hospital