Diabetes and Fasting during Ramazan from a Doctor’s Perspective
Muslims across the world are enjoying the days of Ramazan and InshAllah will reap all the rewards promised throughout the days and nights of this blessed month. Allah SWT mentions in glorious Quran’s Surah Al Baqarah 2:185 ‘Ramadan is the month in which was sent down the Quran, as a guide to mankind, also clear signs for guidance and judgment (between right and wrong).So every one of you who is present (at his home) during that month should spend it in fasting, but if anyone is ill or on a journey, the prescribed period should be made up by days later (Qaza)’.Allah intends every facility for you; He does not want to put you in difficulties.(He wants you to complete the prescribed period, and to glorify him in that he has guided you’.
This verse from Surah Al Baqarah clearly shows that Ramadan is a month of blessings for Muslims however under certain circumstances and conditions Muslims are not under obligation to fast if they are physically unable to do so. There is a difference of opinion regarding the issue of making up for the missed days of fasting. Although the Holy Quran clearly says that fasting must be made up by either fasting on other days (Qaza) or by paying money to the poor or providing them a meal for each missed day (Fidyah). Islamic scholars argued that Fidyah does not mean the rule of Qaza does not apply so then both have to be practiced however many scholars have passed a Fatawah which excludes Muslims having any severe chronic illness from fasting as long as they pay Fidyah.
Muslim scholars agree that if an illness prevents you from fasting or may exacerbate illness making it life threatening fasting can be either refrained from or fasting may be observed and broken if the person is unwell or needs medication at once for example inhaler in the case of asthma or attack of hypoglycemia in diabetes. This fatwa is backed by the following verses of surah Al Baqarah 286 “Allah does not burden a soul with greater than it can bear”
Complications of Diabetes during fasting:
Diabetes requires adequate blood sugar control which includes both medication such as Insulin and oral hypoglycemic medicines and regular small frequent meals. In case of insulin injections fasting can be observed as it does not break the fast however various considerations must be made before deciding to fast which involves the state of health during three months before the month of Ramazan. It is recommended under following conditions fasting must not be observed during the Ramazan. These conditions include an attack of hypoglycemia during the past three months. Concurrent illnesses such as heart disease, kidney disease along with diabetes which can make it difficult to observe fasting. In above mentioned conditions fasting is not advisable and should be refrained from. It is advised that if fasting has to be observed in these conditions; a doctor should be consulted to make necessary alternation to one’s medication regimen and dietary modification which should be strictly adhered to and if the blood sugar is low or high fasting must be broken (on which a majority of Muslim scholars agree) and medical measures must be taken. Fasting with diabetes poses the following risks which must be considered before observing fasting:
Ketoacidosis which can cause coma and even death.
The other risks include thrombosis or blood clot formation and abrupt weight changes. This is why a full health and risk assessment is necessary to ensure it is safe to fast. If a person can cope with fasting then blood sugar must be monitored by self-blood sugar monitoring kits at the time of Sehari. If sugar levels drop fasting should be broken and ketone bodies must be checked. As long as no frequent medication is required fasting can be observed however sugar level during fasting can rapidly drop so precautions must be taken. Without precautions the risk of hypoglycemia in diabetes type 1 was found to be 4.7 fold and 7.5 fold increase risk of severe hypoglycemia in diabetes type 1 and type 2 patients respectively. The risk of hyperglycemia was found to increase hyperglycemia or high sugar in the blood by 3 fold and 5 fold in diabetes type 1 and type 2 patients respectively. These figures show how careful a diabetic person has to be while fasting. Diet, medication and exercise all play an important role in how blood sugar control is achieved.
Conditions of high risk in which one should refrain from fasting,
The following conditions associated with diabetes are considered to be high risks and life threating which includes; Severe hypoglycemia, ketoacidosis or Acute illness such as hyperosmolar hypoglycemic coma Unawareness of hypoglycemia/Poor glycemic control such as moderate hyperglycemia blood glucose 150-300 mg/dl, type 1 dibetes, living alone or elderly, having Co morbidities such as renal disease requiring dialysis, epilepsy or heart disease.
Conditions of Risks where after a medical check-up when can fast include:
Moderate risk included individuals with short acting insulin or a combination of insulin and oral anti-hyperglycemic drugs. Low risk include well controlled diabetes treated with lifestyle modifications, metformin, DPP-4 Inhibitors, Thiazoladinediones in otherwise healthy individuals with no risk factors.
Islam is a religion of enlightenment and Ramazan is the month of countless blessings acting as a shield against sin. Wherever possible as Muslims we are obliged to observe fasting, however if health does not permit Muslims can either refrain from fasting or break a fast under life threatening conditions or circumstances. In diabetes medical advice should be sought and precautions must be taken before deciding to fast so one can enjoy the blessings of Ramazan without compromising ones health. Remember even if you cannot fast Allah is forgiving and understanding of health constraints and fidyah may be offered.