During Ramadan month, all Muslims around the world must fast from dawn to sunset. They are only allowed to take food during night time and observe fasting during the day. In a healthy person, fasting would not pose any problems. However, in patients with diabetes (type 1 and type 2) fasting during the Ramadan month may risk them succumbing to complications if they do not take precautions.
"The large proportion of both type 1 and type 2 diabetic patients who fast during Ramadan represents a challenge to physicians to provide more intensive education before fasting and emphasizes the need for closer monitoring of blood glucose during fasting." - (EPIDIAR) study
Studies also show that there is a shift in meal time, pattern of meals, type of food eaten and total caloric intake during Ramadan month.
"Medical advice is sometimes ignored for religious reasons. Occasionally a devoted Muslim will say, 'Allah will protect me'. He or she may not fear death or may even want to die so as to meet the Creator. Counsel the patient by saying 'to see the doctor and comply with treatment is Prophet Mohammad's sunnat (precedent)'. To refuse would be a sin." - JRSM (Journal of Royal Society of Medicine)
It is important to inform Muslim patients that it is not a sin to skip the fast if they are found to have medical problems. Most of the doctors would advise patients to avoid fasting if they have medical conditions such as acute peptic ulcer, pulmonary tuberculosis, bronchial asthma, cancer, diabetes Type 1 and Type 2, who have poor glycemic control (HbA1c >12%), non-compliance with diet or drug/oral regimes, four or more episodes of hypoglycemia and/or hyperglycemia during preceding month, on 2 and more insulin injection per day, urinary calculi, cardiovascular disease, psychiatry, liver disorder, hepatic dysfunction where liver enzyme is more than twice the upper normal limit or pregnancy.
Risks associated with patients suffering from diabetes include hypoglycemia, which includes symptoms such as shaking, tremor, sweating, anxious, dizziness, hunger, fast heartbeat or palpitation, impaired vision, fatigue or weakness, headache, poor concentration and irritability.
Patients with diabetes should always discuss with their medical doctors prior to making the decision to fast during Ramadan month. In fact, they should be given pre-fasting assessment and counseling along with intensive education on the complications of diabetes.
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