Diabetes and Ramadan

Monday, 14 July 2014


During Ramadan, Muslims abstain from food, drink, use oral medications and smoking during daylight hours, before fajr (dawn) to sunset. Fasting during Ramadan is obligatory upon every sane, healthy Muslim whose reached puberty and is not traveling during the time of fasting. But how can Muslim diabetic patients restrain from eating their drugs? What are the complications that they may face during Ramadan? 


Retrieved from 'Diabetes and Ramadan', The Aga Khan University Hospital.

Islamic rules allow patients with diabetes not to fast if the condition can cause complications or any severity. According to Al-Quran, it specifically exempts the sick from the duty of fasting (Holy Koran, Al-Bakarah, 183–185), especially if fasting can lead to harmful consequences to the patients. Patients with diabetes are categorized in this type of people because the altered meal and fluid intake during Ramadan may increase the risk of various complications. If the patients wish to fast with medical practitioners’ advice, it does not matter. Here, physicians, pharmacists and dietitians are the most important people who should know how to handle these patients. The treatment of diabetes is to provide the stability of blood glucose level and reduce the risk of various complications. The daily caloric and carbohydrate intake are decreased during Ramadan. It could be due to only two times of meal taken; Iftar (breaking of the fast meal) and Suhur (predawn).

In several studies reported that body weight does not change during the fasting period but other studies reported a decreasing in mean body weight during Ramadan. Reduction in body weight among diabetes patients can give health benefits in terms of decreasing the risks of diabetes complication. However, Muslim diabetic patients also have tendency to increase their weight and increase the risk of hyperglycemia when they take substantial quantities of sugary fluids such as carbonated drinks together with fried foods and high carbohydrate meals. The major change in dietary patterns can cause the unbalanced of blood sugar level.

Hypoglycemia can happen when patients do not eat or less eats which makes low sugar level in the body. Some studies say hypoglycemia could happen in type 1 and 2 diabetes and some say glycemic does not change in type 2 diabetes. Several studies have shown the HbA1c and fructosamine do not change during Ramadan and in some cases the levels decrease during the month. Insulin and C-peptide levels do not change but uric acid level increases among Muslim diabetic patients. How about lipid profile? Some studies have shown that there are no changes on triglycerides, LDL and HDL cholesterol. But several studies have shown a decrease in triglycerides and increase in LDL and HDL cholesterol. One study has reported a decrease in responsiveness of platelet aggregates as well as decrease the occurrence of thrombosis in type 2 diabetes patients at the end of Ramadan.

If Muslim diabetic patients wish to fast, it is necessary to advise them to control the glucose levels; prevent hypoglycemia during the days and prevent hyperglycemia during the night. The meals during suhur and iftar should be low in saturated fats and carbohydrates. Eat more vegetables and healthy fats include monounsaturated and polyunsaturated fats. Consult with dietitians to know the exact distribution of carbohydrate, protein and fat during Ramadan. Maintain appropriate and healthy diets to gain benefits during Ramadan.





References:
Diabetes and Ramadan: Review of the literature. (2006). Diabetes Research and Clinical Practice
Recommendations for Management of Diabetes During Ramadan. (2005). American Diabetes Association

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