Ramadan:
Fasting month for Muslims
Faiz Marikar
Ramadan is the ninth lunar month of the Islamic year and fasting
during the month is one of the five pillars of Islam. It is obligatory
for all healthy adults of the Islamic faith to fast between the hours of
dawn and sunset. In Holy Quran Sura 2: verse 185 said that; The month of
Ramadan is the month when the Quran was sent down as guidance for
mankind with clear proofs of guidance and the criterion by which to
distinguish right from wrong.
Therefore, whoever of you is present in that month, let him fast; but
he who is ill or on a journey shall fast a similar number of days later
on. God desires you to fast the whole month, so that you may glorify Him
for His having guided you and so that you may be grateful.
As well as the change in dietary pattern there may be a change in
content, with increased intake of fat and carbohydrates. These changes
in dietary habits present serious problems for patients with diabetics.
Normally this won’t happen for normal meal break fast with starting from
three dates and light break fast. People forget that they are fasting
after break fast and eat like nothing, end up even obesity.
Scientific finding revealed that in people who are well normal
homoeostatic mechanisms seem to cope; urinary volume, pH and nitrogen
excretion remain within physiological limits. But some studies have
reported substantial weight loss and increased plasma concentration of
urea and uric acid consistent with catabolism of body mass, but these
findings have not been confirmed.
What issues you should cover - before fasting
* Explore the motivation of fasting - whether he wants to fast (as
most will) or whether he is looking for a ‘legitimate’ exemption from
fasting on medical grounds. In this point Quran stated in Sura 2;Verse
184; For those who can fast only with extreme difficulty, there is a way
to compensate - the feeding of a needy person. But he who does good of
his own accord shall be well reward.
This Quran verse says only who are sick, and pregnant women, are
allowed to break fast.
* Although everyone agrees on the need to avoid food and drink during
daylight hours, a range of views exists on the use of drugs. Ask his
opinion on the use of and injectable drugs when fasting. This is allowed
unless vaccination is not to fill your hungry.
* Find out how long the fast will last. The length of the fast varies
according to the time of year in which Ramadan falls. Ramadan starts on
about August 1 this year and in the Sri Lanka the fast will be about
13-14. If Ramadan falls in United Kingdom in this summer, fasts can last
for more than 18 hours, in which case fasting for people with diabetes
can prove more challenging.
* Inquire about his current treatment regimen, glycaemic control and
comorbidities. Achieving good glycaemic control before Ramadan will make
it easier to maintain control while fasting. People taking drugs may
need to change their regimens.
I would like to recommend patients must get the advice from the
physician on this regard.
* If he has some experience of fasting with diabetes, find out how he
fared and if he has any specific concerns.
In managing type I diabetics during Ramadan, health practitioners
need to be able to advice patients how best to fulfill religious
obligations without endangering their health. The result of recent study
stated that Type I diabetics may be achieved by use of twice daily
administration or rapid acting insuling lispro in combination with and
intermediate-acting insulin. Type II diabetic patients have no direct
effect on deteriorating the health and advised to fast in the month of
Ramadan.
What you should do - while fasting
* Explain that the decision is ultimately his, but that you can
advise him and help him maximise his chances of fasting safely. Most
people with well controlled diabetes should be able to fast, but if
fasting is judged unsafe (in those with brittle diabetes or cardiac or
renal complications (or a combination)), clearly communicate this. Most
people will be receptive to such advice, even if they choose to ignore
it.
* Encourage him (ideally with input from a dietitian trained to deal
with cultural issues) to eat foods that are high in dietary fibre (such
as whole grains, fruits and vegetables) and have a low glycaemic index
(such as beans and pulses) at the pre-dawn (Suhur) and sunset (Iftar)
meals to promote glycaemic control.
Discourage him from eating foods with a high glycaemic index (such as
more than three dates, which are traditionally used to break the fast)
until about half an hour after taking drugs to minimise sharp rises in
blood sugar at sunset.
* If blood glucose is well controlled by diet alone, advise him that
fasting is safe. Scientific findings revealed that blood glucose and
pressure can be controlled by fasting.
* Self monitoring of blood glucose is essential for safe fasting in
patients taking antidiabetic drugs, particularly before and after the
pre-dawn and sunset meals.
It should guide the individual tailoring of treatment regimens
described below.
* To minimise the risk of hypoglycaemia, advise patients taking oral
hypoglycaemic agents as follows:
If taking a long acting sulphonylurea, switch to a short acting
preparation or metformin, or both
If a single daily dose is used, take this with the sunset meal
If two or three doses are taken each day, take half the normal
evening dose before dawn and the normal morning (and any midday) dose
after sunset.
Advise patients taking insulin as follows:
If a once daily dose is used, switch to a twice daily regimen
If a twice daily regimen is used, take half of the evening dose
before dawn and the normal morning dose after sunset
If basal bolus insulin is used, reduce the long acting component to
two thirds of normal, split into two equal doses taken during the sunset
and pre-dawn meals. Take the rapid acting component as before, but omit
the middle dose.
* Emphasise the need to carry dextrose or glucose tablets at all
times to treat hypoglycaemia; explain the importance and legitimacy of
breaking the fast in emergency situations.
* Encourage moderate exercise, patients are not advise to pray
special night prayers, if they advised by consultant that health will
deteriorate.
* Arrange for a review one week into Ramadan or earlier if concerns
arise.
If you need further assistance on detailed about what issues and what
you should do please refer your doctor firsts and get the assistance,
please refer the article which was published in British Medical Journal
Consultation section in the year of 2007.
The writer is a Senior Lecturer, Medicine and Allied Science
Faculty, Rajarata University |