By Abdullahi Jamaa
Diabetes is one of the largest global health emergencies of 21st century that continue to affect people of all ages. With a huge economic and social burden, its prevalence is undoubtedly a health crisis of monumental proportion.
According to International Diabetes Federation (IDF) the comparative prevalence of diabetes is well above the global average in the Muslim world. It means therefore that a considerable population of Muslims have to contend with its threat throughout their life and more demandingly during the Holy month of Ramadan.
Despite religious exemption overwhelming majority of Muslim patients observe fasting with little or no self-care. According to the Journal of Fasting and Health, approximately half of the patients with type 1 and two thirds of patients with type2 diabetes observe fasting.
Currently an estimated 148 million Muslims are battling with diabetes worldwide. Many of these people are living in Middle East and North Africa where lifestyle diseases are more prevalent due to unhealthy widespread practices.
Although majority of studies on Islamic fasting indicate that no major problems are encountered by patients with type 2 and even well-controlled type 1 diabetes during Ramadan, epidemiological researches conducted over the last few decades indicate that Ramadan has a major impact in the management of diabetes among Muslim populations.
Observing Ramadan, the fourth pillar of Islam is a do or die affair for the majority of Muslims. However many patients put themselves into unnecessary complications for taken up extra calories and sugar rich food during iftar and suhoor times.
Dr. Faruk Ali, a medical expert says doctors report increased complications during Ramadan as fasting takes toll on patients who don’t follow acceptable diabetic management guidelines.
“Some medical experts advocate not to fast during Ramadan while others say it is okay to fast as long as one can monitor the body sugar levels and takes medication as prescribed” said Dr. Faruk
Taqwa (piety) is a major factor influencing a diabetic to fast. The patient may feel that he would not be discharging his duty as a Muslim, notwithstanding the fact that he is aware of the exemption granted in the event of a burdensome disease.
Medical experts say the management of diabetes during Ramadan requires personal dedication and commitment that must be in line with medical practices .They say with so many Muslims with diabetes deciding to fast, the importance of following proper dietary and medicinal guidelines is important.
Fasting has a number of physiological effects on the body even for non-diabetes. In patients with diabetes the changes to their body can be associated with development of complications resulted by unsteady body sugar levels.
The risk of complications that face fasting patients depends on a number of factors that includes: the type of diabetes, level of glycaemic control, medication, presence of comorbidities and personal circumstances.
The Muslim patient must therefore understand the importance of acquiring important education on dealing with diabetes, the required diet and monitoring of blood sugar levels in order to observe an awesome Ramadan free of complications.
“Awareness of symptoms such as hypoglycaemia (low sugars) sweating, tremors and headaches is important. Patient must be educated to know these symptoms and it should prompt quick check of blood sugars “notes Dr. Faruk
Nutritional therapy
In dealing with diabetes during Ramadan, dietary principles should be reinforced. It is common practice in most Muslim communities to consume large quantities of fried foods and carbohydrates during the time of breaking fast.
Moreover, sweet foods rich in fat, sugar and milk solids are often taken at these times. These haphazard uptake of meals constitutes a health danger for diabetic patients. Expert emphasize that the benefits of fasting appear only in patients who maintain their appropriate diets.
High volumes of food laden with carbohydrates and complex sugar taken especially during iftar is a calling for complications and must be avoided at all cost. Instead, a patient must adhere to a nutritional therapy during non-fasting hours.
“The idea here is to avoid low blood glucose which is worse than high blood glucose. Doctors recommend long acting carbohydrates (rice, oats, pasta etc) during suhoor as long as medication is taken as prescribed” says Dr. Faruk
For patients with diabetes, Ramadan may provide a perfect opportunity to improve diabetic management as long as they focus on self-care, regulate their medication and meal timing.
The goal of appropriate nutritional therapy is to help maintain a near-normal blood glucose levels. This can be achieved through balancing of food with intake of prescribed drugs to achieve optimal lipid levels.
The prevention of acute and chronic diabetic complications also requires use of certain types of medications. However, it would not be advisable to make any changes in medication without consulting your doctor.
“Diabetes is quite dangerous and difficult condition if close follow up is not done. It is both the Doctor and the patient’s responsibility to make sure the glucose is controlled and cormodites well managed” advises Dr. Faruk
Doctors further advice that people who treat their diabetes with insulin may be advised not to fast especially those with type 1 diabetes whose control is poor and who are prone to ketoacidosis.
While for those who do decide to fast, the most important message is not to stop taking insulin during Ramadan. They need to be very careful to make appropriate adjustments to their insulin dosage with help from their doctors.
Meanwhile, recent studies indicate that light to moderate regular exercise during Ramadan is harmless for patients. It has been shown that fasting does not interfere with tolerance to exercise. However rigorous body exercise may result complications and must be avoided.
“It is also paramount to check blood glucose before and after exercise. Any vigorous activity can trigger blood glucose fluctuations. Patients must avoid insulin therapy before exercise instead they should take a small carb meal.” advises Dr. Faruk
Finally, Allah has created every human being in a unique way. Our bodies are different and its reactions to the environment, diet and medications is varied. It’s highly advisable that diabetic patient who are fasting should be in constant contact with their doctor to avert any complications.
