With the advent of the new moon of Ramadan, Muslims are competing in carrying out the obligations and Sunnah acts to draw closer to Allah The Almighty and to receive the reward in the month of Ramadan. When Allah The Almighty prescribed fasting, He granted concessions for certain categories of people. Allah The Almighty Says (what means): {So whoever among you is ill or on a journey [during them] - then an equal number of days [are to be made up].}[Quran 2:184] Therefore, we have to understand that Allah The Almighty has enjoined us to fast for a purpose which will bring about benefit for us. By no means could fasting be intended to inflict harm from a health standpoint, especially for diabetic patients.
Why the diabetic patient?
Diabetes is a condition that requires a pause with the fasting of Ramadan. There are a group of diabetics who are allowed to fast while others are at risk in the event of fasting. In order to understand the medical reason for that, we should clarify the following points:
A diabetic patient is exposed to low blood sugar levels during the day in Ramadan, as well as in the second half of the day (after the Iftaar (fast-breaking meal)). The patient abstains from eating, especially sugars, for hours throughout the day, and since he does not store sugars in the liver, he cannot use this method to retrieve sugar from the liver to the blood like healthy people. This exposes him to low blood sugar levels, but with varied danger depending on the type of condition and medication being taken.
Diabetics who are taking insulin are at risk of coma while fasting, while those treated by a healthy diet suffer from low blood sugar levels that is less serious, represented in the following signs: feeling hungry, shivering, dizziness, and cold sweating. This requires taking necessary actions quickly such as eating quick sugars like juice or chocolate – followed by slow sugars like bread. Otherwise, it is possible that the situation develops into a coma.
Additionally, there is the danger that blood sugar levels will rise during the night of fasting because of the excessive appetite after a full day of fasting. Also, having one's meal with the family encourages the person to eat more, as well as the fact that the majority of dishes prepared during the blessed month are either made of quick sugars or eaten accompanied by quick sugars.
All these factors expose the patient to the difficulty of respecting his healthy diet for a period of 29 or 30 days consecutively. Therefore, a diabetic patient may be transformed from a reassuring and stable situation to exposure to severe complications, which are not serious, but chronic. It may become more serious, particularly as they are not discovered until the months after the end of Ramadan, and the consequences are conditions such as weak eyesight, weak kidney function, injury in the legs, or sexual impotence. Since these symptoms do not appear immediately, it is difficult for the patient to link between these symptoms and the main indirect cause, which is fasting.
Important tips:
Therefore, we recommend that the diabetic patient sees his specialist doctor before he starts fasting to learn from his guidance since each case requires very specific directions, taking into account the following:
Diabetic patients treated with insulin from childhood and youth must not fast, because the level of sugar at this stage is not stable, where the decline in the percentage of sugar in the blood is certain and dangerous in the case of fasting. It may result in a coma associated with serious complications with regard to the function of the brain if the patient could not receive exact and very rapid treatment.
Diabetic patients treated with diet and pharmaceutical drugs can fast if the blood sugar level is steady and they do not suffer from any problems in the kidneys or the liver.
Diabetic patients suffering from liver failure must not fast, because fasting entails danger to their lives, sometimes leading to coma.
Diabetic patients suffering from kidney failure must not fast, because they need a certain amount of liquid that cannot be achieved regularly with fasting.
What if a diabetic patient fasts?
There are important instructions for the diabetic patient if the doctor permitted him to fast. They can be summarized as follows:
1. Seeing a doctor of diabetes and endocrine glands at least one week before the start of the month of Ramadan.
2. Maintaining a healthy diet and exercise program prescribed by the doctor, and it is usually advisable to play some kind of sport or take an activity such as walking for at least half an hour a day.
3. Maintaining the times of drug treatment, or arranging its time in a way that suits the period of fasting with the doctor.
4. Avoiding eating sugars immediately before bedtime.
5. Resisting the quick sugars that we often eat in the evening, including candy and juice.
6. Taking the drug 15 minutes before breakfast to avoid an abrupt rise in blood sugar levels during breakfast.
The diet should be diagnosed by the patient’s doctor, and many facts must be taken into account, including age, weight, sex, and the types of professional and sports activities. Therefore, it makes sense to sort the diet according to these data. Nevertheless, there are some dietary recommendations for all diabetic patients to follow:
1. Eating three main meals with a snack between the Iftaar (fast-breaking) and Suhoor (pre-dawn) meals.
2. There must be a period of time not less than 4 hours between each meal.
3. Drinking liquids between meals on condition that they have high sugar content.
4. Eating protein, milk, dairy products and vegetables with limited quantities.
5. Eating calculated intakes of bread, starches, and pasta. It is necessary to avoid an excessive drop in the proportion of sugar, taking into account that excessive consumption of such substances will lead to the reverse. It is preferable to eat brown bread instead of white bread because it contains less carbohydrates.
6. Eating fruits is necessary to have the vitamins, mineral salts, and a certain percentage of sugar necessary for diabetic patients, but all these things must be taken in a reasonable quantity, for example, a medium-sized serving of fruit after the Iftaar and Suhoor meals in Ramadan.
7. Avoiding eating quick sugars that cause a sudden rise in the blood sugar level.
The religious instructions in this regard are clear. Anyone for whose health fasting is harmful is permitted to break his fast, along with paying an expiation fixed by the Islamic Sharee‘ah according to one's capacity.
Quick and slow sugars
Here is a tiny glimpse at sugars in order to understand things more clearly. Sugars are classified into two categories:
Simple sugars: they consist of one or two molecules of sugar (glucose, fructose and sucrose). For example, a sugar cube put in a cup of tea in the morning falls under the category of quick sugars, as well as all the sweets commonly eaten in the month of Ramadan. They are also able to give you instant energy that can be exploited.
Complex sugars: they contain carbohydrates, consisting of a long chain of molecules, such as those found in sweet potatoes or various types of cereal crops. These are considered slow sugars because they gradually give you energy after eating and allow you to exert effort for a long time.
Finally, food and drinks are a blessing that we should enjoy, but without extravagance. Having much of them is contrary to the nature that Allah The Almighty created us on and that which we have to adhere to. By following the points mentioned above and making them a way of life, we would guarantee correcting any incorrect ietary habits for the diabetic patient, and thus enable him to enjoy a healthy and active body, a flexible and calm life, and a reward in the Hereafter.
We ask Allah The Almighty to grant our Muslim Ummah (nation) acceptable fasting, rewarded deeds, and delicious Iftaars.