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The month of Ramadan begins this year on 19th June. For the millions of Muslims in the UK, this means consuming no food or water during the daylight hours of the longest days of the year. Going up to 18 hours without sustenance poses a challenge to the will and constitution of even the healthiest men and women – but what if you have a condition like diabetes which means that the food you eat has an immediate impact on your health?
The major risks associated with diabetic fasting are hypo- and hyperglycaemia; when the blood sugar dips dangerously low or spikes dangerously high.
During the day, when Muslim diabetics may not eat, they are at a higher risk of having low blood sugar. Most diabetic medications are designed to break down glucose and reduce blood sugar levels, but during the fasting hours when no food is being consumed, blood sugar levels are likely to already be relatively low. Add to this a drug which actively reduces blood sugar and you have a potential risk of going 'hypo'.
At night time, during the hours of darkness, Muslims observing Ramadan typically enjoy 2 meals – 'Iftar', an evening meal to break the fast, and 'Sehoor', a morning meal before the fast resumes for the day. After 18 hours of doing without, it is understandably tempting to compensate by having 2 large and indulgent meals. However, suddenly introducing a raft of calories increases blood sugar, and could cause a diabetic to become hyperglycaemic. This is a particularly high risk this year, as Muslims in Britain have only 6 hours of darkness in which to eat both of their meals.
So, you want to fast, but you could go hypo in the daytime or hyper in the night – what can you do?
First and foremost, it is very important that you speak with your GP several weeks before the beginning of Ramadan. They will be able to advise you about your current state of health, how well controlled your condition is, and whether it will be safe for you to fast. It may also be necessary for you to change your medication, or use your current medication at different times to accommodate the changes in your eating pattern. If your GP says that it won't be possible to reschedule your medication, you might want to reconsider fasting – Muslim scholars are not all in agreement as to whether taking medication during the day counts as breaking your fast, so if you are told that you have to continue daytime dosing, you will have to make a personal decision about whether you consider this to be a true fast.
Fasting for Ramadan is a very personal decision, and you should not feel pressured to fast if you feel you will be unable to cope with the health implications. In the Qur'an states that your life and your body are a gift from Allah ('do not take life which Allah has made sacred'). If fasting is going to damage this gift, it is better to observe in an alternative way like giving to charity or deferring the fast until your condition is better controlled.
If, after consulting your Doctor, you are confident that you can go ahead with the Ramadan fast, following these tips can help you to remain healthy throughout the month:
- Wake before dawn for Sehoor – in the Summer months, when the sun rises very early, many Muslims choose to eat Sehoor at midnight rather than wake for a dawn meal. For diabetics, it is very important to space out your meals as much as possible to avoid hyperglycaemia.
- Include complex carbohydrates and protein in your dawn meal – this will make you feel fuller for longer, and release energy over a long period of time to avoid peaks and troughs in blood sugar.
- Take care when you break your fast – try to eat moderate portions for Iftar, and avoid foods which are high in fat and sugar.
- Be flexible – check your glucose regularly (Muslim scholars now agree that this is not breaking your fast). Keep an emergency snack close to hand – a banana or some glucose tabs are ideal – and be willing to break your fast if you feel unwell, or if your blood sugar is not within safe parameters.
- Your blood sugar should never drop below 3.9 mmol/l or rise above 16 mmol/l. If your blood sugar is outside of this range, stop fasting immediately and seek medical attention.
- If you have had to break your fast for any reason, seek medical advice before resuming it – it may be possible for you to start fasting again the next day, but if not don't forget that you can fast at a later date to 'make up for' the time you've lost during Ramadan.
Still not sure whether the Ramadan fast is right for you? Many Muslims practise fasting for a few days in Sha'aban, the month before Ramadan – so if you want to have a go you still have a little bit of time before the 19th.