Fasting in during pregnancy
In pregnancy, there is always a consideration of “two in one”- the mother and the fetus. In the early part of pregnancy, the need of the fetus is insignificant; however, the mother usually goes through morning sickness and sometimes emotional changes. Depending on the degree of changes one may need medical attention and/or psychological counseling. As the pregnancy progresses, the mother enters into different phases of physical changes and the needs of the fetus also continue to grow. The average daily calorie requirement of a growing fetus is 300 kcal which can very easily be provided from mother’s calories. Therefore, as long as the mother is taking an adequate amount of calories, that should suffice the need of the fetus.
In the state of fasting, in case of normal pregnancy, the requirement of total fluid and calorie intake is no different than that of the pre-pregnant status. However, what is more important is the tremendous physical and emotional adaptations that are necessary to ensure a normal outcome of pregnancy. Therefore, any additional factor that may influence this delicate balance should be avoided. Since the degree of physical and emotional changes and the degree of adjustability to these changes will vary from one person to another and according to their experience, recommendation regarding fasting in [during] pregnancy must be individualized. “Not to fast during pregnancy” is a blanket concession that conforms to what Allah Says (what means): “. . .Allah intends for you ease and does not intend for you hardship …” [Quran 2: 185]
Using this concession is advisable when necessary, keeping in mind that this is only a deferment, not an exemption.
Diabetes mellitus and fasting
Diabetes Mellitus is a common problem. It is a serious, chronic and irreversible condition; however, it is controllable with prudent management schedule.
Allah Tells us that fasting is a means of attaining piety. Because there are so many spiritual benefits in fasting. Many Muslims find it hard to let such opportunity pass by without deriving any benefit from it. Therefore, they will resort to fasting despite their knowing that they could defer it or make arrangement for atonement.
From a medical point of view, fasting has a soothing effect on the mind, and it helps one achieve inner peace and self control. It also helps in controlling blood sugar and blood pressure by controlling eating, excitement and anger.
On the other hand, besides suffering from clinical symptoms of polyuria, polydypsia and other complications, a diabetic patient also suffers from psychological symptoms arising directly from changing blood and CSF osmolality, constant demand of discipline and compliance, fear of long term complications and threat of hypoglycemic attacks and possibility of dehydration and coma. (“Diabetes Mellitus and Fasting,” Shahid Athar, M.D., journal of IMANA, March 2006)
Because of the spiritual and medical benefitsm on one hand, and adverse consequences (in some cases) of fasting, on the other hand (in some cases), any recommendation for or against fasting should be made only after a global evaluation of a patient. In such evaluation an answer to the following questions may help in arriving at a reasonable recommendation:
1. Is there a group of diabetics who can be safely guided to fast?
2. Should every diabetic who wants to fast be allowed to do so?
3. Is there a group of diabetics who should be advised against fasting?
4. Can some diabetics benefit from fasting?
5. How dependable is the patient?
6. Are there any associated compounding medical/psychological conditions?
The above questions can be briefly answered as follows:
1. Fasting encouraged––Patients with uncomplicated metabolic syndrome including obesity, type 2 diabetes mellitus, hypertension, and/or hyperlipidemia. Fasting in this group of patients will have therapeutic effect.
2. Relative indications––Patients with the following criteria can relatively safely be guided to achieve Ramadan fasting [fast Ramadan]:
a) Age above 20, ideal or above ideal body weight, stable diabetes on oral hypoglycemic.
b) Free of any complication or any compounding medical problem (infection, or renal, cardiac, pulmonary, vascular and/or neurological conditions).
c) Should have the following biochemical parameters: Fasting blood sugar between 110-120 mg/dl, 2-hr post-prandial blood sugar not exceeding 160 mg/dl, and HbA 1c less than 7%.
3. Relative contraindications––Diabetic females who are pregnant and nursing mothers.
4. Patients who should not fast:
a) Type 1 and unstable diabetics
b) Presence of infection and other life threatening systemic diseases
c) HbA 1c over 12% or history of frequent hypoglycemia.
Educational program for diabetics during Ramadan:
Patients should be able to:
1. Recognize the symptoms of hyperglycemia, hypoglycemia and dehydration and the importance of breaking fast as soon as any complication occurs.
2. Monitor blood sugar, check urine sugar and urine acetone, daily weight, calorie-controlled diabetic diet and carry on normal physical activities.
3. Monitor vital signs; recognize signs of infection and any alteration in mental state.
4. Follow dietary advice, drug regime adjustment and seek help if a problem occurs.
Dietary guidelines and adjustment of medication
All patients with diabetes who are willing to fast should be under strict supervision of [by] their physician. Patients should start preparing themselves 2 to 3 months before the onset of Ramadan and strictly follow the guidelines given by the physician. These may include a physical examination, blood and urine tests, and a CMP among others. Special attention must be paid to any change in the schedule of oral medications and insulin injection.
In conclusion, concessions are mercy from Allah. One should take advantage of the concessions when the reasons are legitimate; however, it should not be misused out of insincerity, a state that is capable of developing into disobedience.
The scholars and the physicians can set parameters for different categories, but the actual limits should be set by the sincerity of the individual. For some of us, we should know that where there is a will there is a way, as Allah Says (what means):
“. . . And whoever fears Allah - He will make for him a way out.” [Quran 65:2]