Fasting is a period of abstinence from food or drink. Experts urge that Muslims with diabetes embarking on fasting should consult their doctor for medical assessment, appropriate alterations to their medication and lifestyle to ensure healthy fasting, reports Sade Oguntola.

Recorded since the beginning of time, Ramadan is a period of abstinence from food and drink, which lasts for a lunar month. During Ramadan, fasting is observed during the hours of sunlight and it is undertaken to promote chastity and humility and as an act of submission to Allah.

Fasting during Ramadan is generally considered compulsory, except for the sick, the pregnant, the elderly, nursing mothers and children. Moreover, if a fasting person becomes ill, he or she is allowed to end the fast in the day.

In meeting the religious obligation during Ramadan, are Muslims supposed to jeopardise their health? Although the sick are exempt, many sick people and others with diseases such as diabetes and cancer that require daily intake of medications continue to fast and, therefore, abstain not only from eating and drinking water but also from consuming their medications. They also miss hospitals and other medical appointments.

While fasting is a commendable spiritual practice, it is one that could come with major health challenges for a Muslim with diabetes. Ramadan directly influences the control of diabetes because of the month-long changes in meal times, types of food, use of medication and daily lifestyle. And for that reason, many health care providers discourage people with diabetes from fasting during Ramadan.

But Dr Olubiyi Adesina, a consultant endocrinologist, Federal Medical Centre, Abeokuta, Ogun State, stated that a Muslim with diabetes can meet this religious obligation during Ramadan without it jeopardising his or her health, provided some conditions were met.

Dr Adesina, a member of Strategy for Improving Diabetes in Nigeria (SIDCAIN), a group of experts into diabetes prevention, stated that fasting with diabetes requires careful diabetes management to prevent blood glucose levels from going either too low or too high.

According to Dr Adesina, “in absolute terms, diabetics would not be told not to observe Ramadan. All diabetics can fast, but under some conditions. Part of this is that, prior to fasting, a good blood sugar control for at least one to two months must have been maintained. The person must equally be well and not hospitalised for one ailment or the other in this same period.  Before such a fast can commence, the Muslim with diabetes would also have agreed with the doctor whether it is safe for him or her to fast.”

Dr Adesina, while emphasising that a person with poor blood sugar control should not fast, stated that there would be the need for adjustment in doses of medication and timing of medicine use for Muslims with diabetes that will undergo fasting to prevent blood glucose levels from going either too low or too high.

Low blood sugar (hypoglycemia) can be dangerous. Low blood sugar can cause anxiety or irritability, loss of concentration and blurred vision. The main symptoms of high blood sugar levels are increased urination, increased thirst and increased hunger. High blood sugar levels can also contribute to frequent urination, weakness or tiredness, loss of weight, increased thirst and vision blurred.

In addition, he stated that considering that during fasting, food intake is reduced, a Muslim with diabetes cannot continue on the same dose of diabetes medications. Also, the timing of the diabetes medications and other medications is important because the diabetic is supposed to eat in the evening and fast at dawn.

Moreover, he pointed out that when a Muslim with diabetes is to break his or her fast, too heavy meals should not be taken because of the reduction in the dosage of diabetes medications being taken. If heavy meals are eaten, then this could push blood sugar levels too high.

Muslim diabetics, which might be fasting also need to be extra cautious of low body water levels or dehydration. “There is a danger of dehydration if they do not take enough water after they break their fast. Dehydration has its negative consequences; it can make the blood start to solidify, what is medically called thrombosis,” he stated.

Dehydration can be mild, moderate or severe based on how much of the body’s fluid is lost and not replenished. Severe dehydration is a life-threatening emergency.

But Dr Adesina cautioned that, at the slightest sign of ill health, a Muslim with diabetes should break his or her fast, stressing that it is much easier to treat complications of diabetes in the early stages than it is once they have developed.

The majority of diabetes complications occur due to fluctuations in blood glucose levels, particularly elevated blood sugar, over a long period of time. Controlling blood glucose levels and blood pressure has been proven to reduce the risk of diabetes complications, including heart disease, blindness, kidney failure and lower-extremity amputations.

Diabetes is becoming increasingly more common throughout the world, due to increased obesity, which can lead to metabolic syndrome or pre-diabetes, leading to higher incidences of type 2 diabetes. The main three diabetes signs are increased thirst, increased need to urinate and increased hunger.

The two main reasons for diabetes are either the body not producing enough insulin or the body cannot use its insulin effectively enough. Insulin is a hormone which helps glucose in the blood to fuel the cells of the body.

When the body does not produce enough insulin or the body cannot use its insulin effectively enough, fatigue or high blood sugar levels results.

Tips for a successful fast:
•Avoid binge eating during the pre-dawn meal and when eating again after sunset. Large meals with excessive amounts of carbohydrate can lead to high blood sugar.

•Go easy on the physical activity while fasting. Too much can lead to low blood sugar and dehydration.

•Monitor your blood glucose more frequently. This is especially important if you have type 1 diabetes or type 2

diabetes treated with insulin or oral diabetes medicines.

•Discuss the fast with your spiritual leader. Because you have a health condition, you may be able to modify your fast in a way that meets your health objectives as well as your spiritual ones.

•Be aware of the signs and symptoms of high blood sugar level and what to do in case you have a medical crisis.

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