created: 30.09.2004
last modified: 30.09.2004
Religious fasting, voluntary food abdication for non - medical reasons that is, is a worldwide phenomenon. Religious Muslims are fasting for 30 days once a year.The Islamic fasting month starts with the beginning of the 9th month of the Islamic moon calendar. That means the Ramadan hasn't got a fixed date but is moving through the year. In 2004 it starts on October 16th. During this month Muslims abdicate food, drinks, tobacco and sexual activity between sunrise and sunset.
Muslim scholars have different opinions whether taking medication breaks the rules of fasting or not. It is generally accepted that injections, which are not food replacement but are needed to continue medical treatment (like penicillin, insulin or vaccination) don't break the fasting and therefore are allowed. If medication is taken in oral form it breaks the fasting because it is similar to eating. Some religious Muslims don't take medication of any sort during daytime while fasting.
Another problem for diabetics is the change of the eating rhythm during the month of Ramadan. Since the only meals are eaten in the morning, before sunrise and in the evening, after sunset, the insulin medication needs to be adjusted to the changed daily routine. It is possible to use long-term insulin but that needs to be discussed with a doctor or Diabetologist beforehand.
One thing should be clear for a diabetic: fasting may never do any harm but bring people closer to Allah and increase the belief. This is the reason why, besides pregnant women, travelling people and children, also the acute or chronically ill are exempt from the fasting rule. On this topic the Koran says that "the necessary overrides the forbidden", that means somebody who can't fast for health reasons is exempt from fasting. This modulation of the rules also applies for the therapy with animal insulin: A diabetic Muslim is allowed to inject porcine insulin. Admittedly nowadays the market for human insulin is so big that diabetics are no longer dependent on animal insulin.
So if you're diabetic but still want to abide the Ramadan, you have to plan more carefully than a healthy person. First of all a few things should be clear: What is my state of health at the moment? How stable is my diabetes, is my blood glucose level under control? Do I feel fit and healthy enough to take another burden beside my disease? Are the people I'm associated with informed about what to do in case of a problem, for example hypoglycaemia?
Doctors advise diabetics, whose diabetes is not in good control not to fast during the Ramadan. If the blood glucose level is fluctuating, if hypo- or hyperglycaemias are occurring, you should abstain from fasting. Also pregnant women, elderly people, children, people with a kidney disease and those who were ill recently should not fast at all. The body has got to cope with a double strain anyway: the diabetes and the lack of food and drinks.
When fasting, it is recommended to constantly check the blood glucose level during the day, and to be more accurate with it than at other times. It makes sense to write a diary that also contains notes about other aspects of the well being of the body.
The evening meal during the month of the Ramadan is a lot more opulent than the morning meal. Sweets and various dishes are the reward for another day of fasting. But also after sundown a diabetic should only take a light and balanced meal.
If complications like hypoglycaemia or acute illness occur during the time of fasting the fasting needs to be stopped and a doctor must be consulted immediately, not only the next day.
Bottom line
Muslim diabetics don't necessarily have to do without the Ramadan, as long as their body is fit. But they should be aware, that the metabolic change that has to happen during one month of fasting is adverse for diabetics. If you are in doubt whether fasting does harm to your body, you better don't do it for the sake of your body's health.
