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Ramazan: Diabetes and Fasting in Summer – How Diabetics Should Plan Their Ramazan

Diabetes is a very common disease and Ramazan is cyclical challenge for its sufferers as well as doctors. The enhancement of spirituality, humility and submission to divine is probably needed to be coupled with a safe passage through the month where eating, sleeping and activity patterns all become drastically different from the routine.

The changes include prolonged period of fasting, sleep deprivation during the night and compensatory sleeping during the day. Reduction of physical activity and two large meals which are traditionally laden with fat and carbohydrate. This is compounded by the long duration of the holy months and geographical and seasonal issues which could prolong the fasting in excess of 15 hours a day. It becomes intense in the heat of Karachi compounded by electricity blackouts and water shortage.

‘Most patients compromise their diet throughout the month due to the stress of coping with the change in lifestyle which also affects their alertness and irritability. With consuming only two meals in larger proportions, long night tarawih prayers of 1-2 hours, though not an obligation, can be grueling for the diabetic patient,’ said Dr Kashif Rizvi, a Consultant endocrinologist.

According to World Health Organization (WHO), every year 9560 male and 12,800 female patients aged 70 and above die due to diabetes, whereas, 22,300 males and 25,400 females die due to high blood glucose in Pakistan.

‘Culturally, sleeping during daytime and stressing one’s self to stay up all night while eating fried and unhealthy food is a common routine during Ramazan. Patients are required to adjust their medication during this time which is also the reason why they are not able to cope with fasting for too long and get more exhausted and stressed by fifteenth Roza,’ said Dr Najia Ashraf, a Consultant Diabetologist in DHA clinics.

The unbearable heat in Karachi during Ramazan has increased the risk of deaths among elderly diabetic and heart patients.

‘The drift of Ramazan into Summer with unpredictable electricity and water supply have made it hard for me to manage my fasting, it used to be much easier when it was in winter and I was younger,’ mused Ghazanfar Ali, a 68-years old businessman who has fasted more than half a century whilst coping with type 1 diabetes.

Religious Obligation or Cultural Pressure?

People with medical issues often find themselves between the rock and a hard place – the medical advice and religious instructions. Whilst it is not for the doctors to comment on religious issues several religious scholars have.

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“Fasting is not an obligation on the sick. One should take doctors’ advice before fasting as Islam has made fasting forbidden for those who have health problems; there is no compulsion in religion,” said Syed Abbas, a religious scholar and speaker.

A Fatwa was also released by Al Azhar University’s Mufti Prof Shawky Ibrahim citing Holy Quran and Hadith.

‘It is allowed in religion to break the fast in order to save one’s health’. The fatwa is also mentioned in the document of International Diabetes Federation (IDF) on guidelines for Ramazan for 148 million Muslims with diabetes worldwide.

Most of the patients in their cultural or societal pressures choose to fast in Pakistan, which creates a challenge for the physicians.

Suggested Guidelines by Physician

Dr Kashif Rizvi talked about the guidelines a patient needs to know before planning to fast during Ramazan. The excerpts are as follows:

Which type of diabetes you have?

Not all diabetes is the same. It is a group of diseases which are all characterized by raised blood sugar, but there are different mechanisms which lead to that. Broadly speaking we categorise them into two categories, type 1 and type 2.

  • Type 1 is an acquired disease, with little genetic component, in which the immune system of the body by mistake attacks the pancreatic cells making insulin. In this case, the person is left with depletion or absence of insulin, so has to take injections from the very beginning. Physicians recommend the patients should not fast because that can rapidly decrease their sugar and it can jeopardize their health.
  • Type 2 diabetes is a group of diseases, which are characterized by mainly insulin resistance or ineffectiveness of insulin. It is characterized by weight gain, a central collection of fat and coexistence of high blood pressure, raised cholesterol etc. However, it is safer to fast with this type. In fact, fasting provides the patients with an opportunity to reduce their weight, blood pressure and cholesterol. Therefore, patients with type 2 diabetes can find a beneficial effect from Ramazan in their disease.
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Your Ramazan Plan

It is very important to create a tailor-made plan to deal with the demands of fasting. Because during Ramazan all the parameters and variables affecting glucose become different. Eating time, sleeping time, exercise, ability and medication timings, dosage, and effectiveness all become different. Therefore, the doctor must follow up with the patient very closely. This should commence weeks before the holy month, the drugs which lower the sugar should be moved towards iftar and the dose of medication towards sahoor should be reduced by half. If somebody is being treated with insulin, they are required to take half the dose in the morning and normal dose at iftar. The physical activity also needs to be examined. While fasting, the blood sugar can drop down, which is called hypoglycemia, so the diabetic patient must check the sugar frequently. Considering the unbearable hot weather, Dr Rizvi stresses on the need to consume ample amount of water to keep themselves hydrated and a willingness to break the fast if the person feels unwell.

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