Roza is a fundamental duty for all healthy adult Muslims. Ramadhan, a lunar month, can last for 29 or 30 days, and its timing changes with respect to seasons and geographical location. The physiological effect of fasting includes lower of blood sugar, lowering of cholesterol and lowering of the systolic blood pressure. The first International Congress on "Health and Ramadhan", held in Casablanca in 1994, entered 50 research papers from all over the world, from Muslim and non-Muslim researchers who have done extensive studies on the medical ethics of fasting.  While improvement in many medical conditions was noted; however, in no way did fasting worsen any patients' health or baseline medical condition.  Fasting during Ramadhan by a Muslim diabetic patient is neither his right nor Islamic obligation, but only a concession to be allowed by his physician, at the patient's request, knowing all the dangers and assuming full responsibility in dietary compliance and glucose monitoring, with good communication between the physician and the patient.
Around 1.5 billion people worldwide (25% of the world’s population) are Muslims. The population-based Epidemiology of Diabetes and Ramadhan (EPIDIAR) study (involving 12 243 diabetics in 13 countries) found that about 43% of people with type 1 diabetes and 79% of people with type 2 diabetes fast during Ramadhan. Based on a worldwide prevalence of 4.6%, we can estimate that up to 50 million Muslim people with diabetes worldwide fast. The Qur’an specifically exempts people with a medical condition from the duty of fasting (Sura Baqra). Nevertheless, many people with diabetes insist on fasting during Ramadhan.
Fasting should be avoided in Type 1 diabetes (Thin subjects usually children, who required insulin from beginning), Type 2 diabetes (adults, obese) with one of the following: High blood glucose (hyperglycemia), brittle diabetes, Insulin pump users, Keto-acidosis, Hypoglycemia, Thrombosis and advanced diabetic complications.
The EPIDIAR study demonstrated a five-fold increase in the incidence of severe hyperglycaemia (requiring hospitalization) during Ramadhan in people with type 2 diabetes perhaps due to excessive reductions in blood glucose-lowering medications. Patient observes increase in thirst, urination and appetite.
Dehydration due to reduced intake of fluids may become severe in hot and humid climates as we have presently in the valley. Increased blood viscosity as a result of dehydration may exacerbate the risk of thrombosis and dehydration may cause fainting, falls and fractures.
Regular self-monitoring of blood glucose (SMBG) several times throughout the day, every day, by meters is essential. Blood glucose at 2-4 pm should be equivalent to fasting and should be kept 70-130 mg/dl. Exercise caution if less than 100 mg/dl and in case of hypoglycemic symptoms they should break the fast.
People should maintain a healthy and balanced diet during Ramadhan. In the non Ramadhan meal pattern is to be 3+3 i.e. three major and three minor meals. The non-caloric fluid intake be increased during the non-fasting hours. The Sehri be taken as late as possible before the start of the daily fast and meals between iftiar and sehri could be increased in number.
Normal levels of physical activity can be maintained and exercise should be preferred after Iftiar or Sehri but not before Iftiar to avoid hypoglycaemia. If Taraweh prayers (long prayer at the time of Isha) are performed, they should be considered a part of a person’s daily physical activity programme.
You should end fast immediately if blood glucose reaches dramatically–60 mg/dl or lower, 70 mg/dl in the first few hours after the start of the fast, especially if insulin, sulfonylureas, or miglitinides are taken at the Sehri, excessively-300 mg/dl.
Pregnant women should be strongly advised not to fast. During fasting, blood glucose levels are lower; but post-meal glucose and insulin levels remain higher. Although pregnant Muslim women are exempt from fasting during Ramadhan, some with known diabetes (including gestational diabetes) insist on fasting. These women  constitute a high-risk group, and their management requires intensive care.
The crucial decision to fast should be made after ample discussion with the treating physician. Highly individualized management plan, and close follow-up is essential.

(Author is Associate Prof Endocrinology SKIMS and can be mailed at ashraf.endo@gmail.com)

Lastupdate on : Tue, 9 Aug 2011 21:30:00 Makkah time
Lastupdate on : Tue, 9 Aug 2011 18:30:00 GMT
Lastupdate on : Wed, 10 Aug 2011 00:00:00 IST