Ramadan And Diabetic Patients While discussing the advantageous effects of Ramadan fasting on the diabetic patients, it should be kept in mind that this type of prolonged fasting may not be suitable for a small number of those diabetics whose blood sugar levels are prone to fluctuate between hyper and hypoglycemia (i.e. high and low blood sugar). Hypoglycemia is more hazardous than hyperglycemia and as such, patients with uncontrolled diabetes and those who are known to have hypoglycemic spells before should not attempt fasting unless permitted by their physicians, as the response to fasting may vary from individual to individual. This is especially important for those who are using insulin injections, as they are more prone to develop hypoglycemia. Obviously for all patients of diabetes insulin and oral drugs need adjustment as a decreased dose is recommended in the early morning when they take their meals. Holy Prophet Muhammad (PBUH) has advised Muslims not to miss the morning meals (Suhoor) and this advice is more applicable to diabetics who should take a good morning meal to prevent hypoglycemia. As far as the diabetic diet in Ramadan is concerned, there is little to change and it should still follow the recommended proportion of derived energy as carbohydrates 50-60 %, protein 10-15 %, and fats 30-35 %. At Iftar or evening breakfast the diabetics should avoid simple sugars such as glucose and sucrose and should rely on starches, fruits and carbohydrates with low glycemic index. Fasting in Ramadan, in general, is particularly good for obese diabetics. The majority of late onset diabetics are obese. Excess weight and obesity by itself is a strong risk factor for non-insulin diabetes mellitus. The relationship of diabetes and obesity will be more clear by knowing the fact that diabetes is three times more common in obese people than in non-obese. As written in Davidson's Textbook of Medicine, "The benefit of weight reduction on the mortality rate of obese in non-diabetic persons is well known and applies even more strikingly to obese diabetics". An obese diabetic is set to lose weight in the month of Ramadan and provided he observes a diet control, it will help reduce the blood sugar level which will consequently decrease the drug dosages required to control diabetes. A month of fasting will also have an effect on abdominal obesity, which is related to the insulin resistance hence the demand for insulin will subsequently reduce. The blood sugar level at any time indicates the sugar level at that particular moment only and is subject to vary throughout the day. However the measurement of glycated hemoglobin HBAic is considered to represent the overall degree of diabetic control. A study conducted on Muslims to see the effects of Muslim type of fasting in Ramadan on diabetic as well as non-diabetic patients was published in the 'Annals of Medicine' in March 1994. In the non-diabetic group, it showed that the average HBAic level before Ramadan was 6.14 +_ 0.12 %, whereas after one month of fasting it reduced to 5.99 +_ 0.67 %. Similarly in diabetics it was 11.16 + - 2.1 % before Ramadan which reduced to 5.19 + -1.11% after one month of fasting. It literally means that Ramadan fasting helps gain a strict diabetic control in majority of patients and this is helpful in preventing or delaying the diabetic complications. Many studies have confirmed that strictness in diabetic control pays off. Strict diabetic control, which includes exercise and dietary precautions, prevents or delays the onset of complications. In Ramadan, a full day's fast means decreased number of calories taken per day and an obligatory walk to mosque for prayers constitutes an ideal light exercise programme which helps attain the diabetic control. Ramadan type of fasting is especially beneficial for gestational diabetes, i.e. diabetes diagnosed for the first time in pregnancy. Gestational diabetes is associated with a high rate of perinatal mortality and neonatal morbidity. Fasting in Ramadan will decrease the blood sugar level and hence will exert an overall effect to prevent the complications and to achieve a good diabetic control. And now let's come to the diagnostic significance of Ramadan. Although the standard test to diagnose diabetes is oral glucose tolerance test but a study published in the 'British Medical Journal' showed that simple measurement of fasting blood sugar or Glycosylated Hemoglobin is also a reliable diagnostic test for diabetes. While fasting in Ramadan a blood sugar test in the afternoon when 10-12 hours have passed after the morning meal showing a raised blood sugar level will be highly diagnostic for diabetes and it could be said that Ramadan offers a good opportunity for all Muslims specially those at risk of diabetes to have a yearly check up for diabetes in any Ramadan afternoon. This will help in detecting the new cases of diabetes. Another diagnostic feature of Ramadan fasting is that in early diabetes, there are more chances of developing reactive hypoglycemia, which may appear when a person is fasting. Hence an early diagnosis of diabetes could be made which will help exerting good control with the help of diet alone. In conclusion, I shall remind that although Ramadan fasting is advantageous for most diabetics, patients with fluctuating blood sugar level or those with poor diabetic control who may need drugs in -between, should first consult a physician before they start fasting as although fasting is obligatory on all Muslims, Allah has exempted such patients as He Himself says in the Holy Qur'an: "Ramadan is the month in which the Qur'an was sent down as a guide to mankind and also clear signs for guidance and judgment. So any one of you who is present during that month should spend it in fasting but if anyone is ill or on a journey the prescribed period should be made up by days later. Allah intends every convenience for you; He does not want to put you to difficulties." (2:185) |
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