Ramadan and diabetes – part two: Adjusting therapy for diabetes during fasting

Harmony between medical and religious authorities is essential to ensure safe fasting for people with diabetes.

In order for this to happen, the following must be achieved:

• Physicians should be familiar with acceptable knowledge of fiqh rulings on this topic.
• Religious scholars should direct patients to consult those physicians who understand the medical and religious aspects of fasting.
• Imams must familiarize themselves with these rules when advising a person with diabetes about the rules of fasting.
• Every communication effort should be made to ensure awareness of diabetes and fasting.

It is important to clarify some essentials for diabetics who intend to fast during the month of Ramadan:

The religious feelings and psychological state of patients with diabetes should not be overlooked or hurt, because most of them find psychological and physical comfort in fasting and will insist on fulfilling this duty despite medical advice not to fast.

It is the duty of the specialist doctor to make every effort to help people with diabetes in their desire to fast. It is also necessary to educate such patients to avoid dramatic changes in blood glucose during fasting and to give them strict instructions to break the fast.

The duration of the fast should be considered, as in some regions, such as Northern Europe, it can last 18 hours or more. This undoubtedly increases the difficulty of fasting for people with diabetes.
It should be emphasized that people who have had diabetes for many years are more prone to chronic complications of this disease, and even if they are classified as low-risk one year, it cannot be assumed that they will still be low-risk the next year.
Other factors that may determine a diabetic patient’s ability to fast should be considered, including general health, lifestyle, environmental temperature, and availability of medical support.

Adjusting medications during fasting

Changing lifestyle and diet during Ramadan puts diabetic patients at increased risk of hypoglycemia during the day and hyperglycemia at night. Recommendations for therapy modification are discussed in detail below.