Razana Allie

 RPN (ICU) Diabetes  Nurse Specialist
SA NCD Alliance (SANCDA) Associate and Diabetes Education Society of South Africa (DESSA) member

Ramadan is approaching and people living with diabetes are advised to plan before starting the month-long fast. Approximately 100 million people with diabetes world-wide fast during Ramadan and most are able to fast the whole month. But this takes planning by all involved, including families, communities and health professionals.

What is Ramadan?

Ramadan is the ninth Islamic month and  fasting during the day light hours is one of the five pillars of Islam. Muslims have been fasting during Ramadan for over 1400 years as prescribed in the Qur’an. Fasting is one part of the religious practices during Ramadan and adults must abstain from eating, drinking, sexual intercourse, use of oral medications, and smoking from before the sunrise to after sunset. There are no restrictions on food or fluid intake between sunset and dawn, however moderation is prescribed.

Most people consume two meals per day during Ramadan: one after sunset (referred to in Arabic as iftar or breaking of the fast meal), and the other before dawn of suhur (predawn).

When is Ramadan?

It varies according to the Muslim (lunar) calendar. This year it is approximately May 15th to June 14th 2018.

What are the diabetes numbers?

  • Over 425 million people worldwide live with diabetes
  • 1 out of 2 adults with diabetes are undiagnosed.
  • About 80% of the world’s population live in low- and middle-income countries, like South Africa, where the greatest increase in diabetes will occur.
  • Diabetes is the #1 cause of death of females and the #2 cause of death for all in South Africa.
  • Muslims comprise almost ¼ of the world population and there are 148 million Muslims living with diabetes.
  • The International Diabetes Federation (IDF) projects that by 2045 the number of people living with the disease will more than double in the Middle East, Africa and South East Asia where the largest populations of Muslims live.

How does fasting affect people living with diabetes?

In people with diabetes the control of blood glucose needs more attention. Complications like low blood sugar (hypoglycaemia) and high blood glucose (hyperglycaemia), dehydration, and blood clots may occur. These are considered to be the “risks” of fasting and are  potentially life threatening and require planning to avoid them such as changes to medication.

Preparation pre-Ramadan is essential and should include risk stratification. All planning must include education,  nutrition, exercise, medication adjustments and monitoring. Ideally this should take place 6 – 8 weeks before Ramadan.

What about fasting when one takes medication for diabetes?

Islam does not burden its followers, there are exceptions for those who are unable to observe the obligatory fast. It is forbidden in Islam to exert oneself in any act that will bring harm upon oneself. Thus, if one is ill and the illness would be aggravated, or the pain would increase through fasting, then fasting is not required.

Those who do fast, are required to review their medication together with a health care practitioner and diabetes nurse specialist before Ramadan so adjustments can be made. In the event of any hypoglycaemia, the fast should be broken immediately and it is advised that the person should not resume fasting until a they consult a health care practitioner..

Who is a high risk during Ramadan?

Risk is assessed according to the following factors: type of diabetes, medication, previous Ramadan experience, hypoglycaemic risk, current complications, co-morbidities and individual work and/or social circumstances.  Examples are old age with ill health, vascular complications, pregnancy and those doing intense physical labour.

What can be done to manage those at high risk of having complications?

Very high risk and high-risk patients should not fast. However, many will fast and these persons should be given the education on how to minimise the possible complications while fasting and thereafter. They should also be given an individualised management plan for reducing their risk for further complications.

  • The management plan should include pre-Ramadan visits, regular self-blood glucose monitoring before, during and after fasting, and a nutrition and exercise plan.
  • The plan must be individualised and tailored to the person’s circumstances, there is no “one size fits all.”
  • It is important to provide additional support to include emergency contacts and availability of a trained health care professionals in diabetes management at all times.
  • Include religious and community leaders, families and community members in the successful and uneventful fasting period.

Where can people find more information about diabetes and Ramadan?

Guidelines on the management of diabetes in Ramadan published in 2016 by the IDF Diabetes and Ramadan Alliance. These guidelines assist health care professionals and persons living with diabetes on the best practices in the preparation and treatment of those who will be fasting.