Ramadan fasting with diabetes is manageable with help

Fasting during Ramadan is obligatory for all healthy Muslim adults around the world, who refrain from eating and drinking between dawn and sunset. The daytime fast is usually broken with a communal meal at sunset and before sunrise the next day. But there are exemptions for the elderly, pregnant or those on regular medications.

In much of Australia, where Ramadan is observed, some 6% of Australian adults are reported to suffer from diabetes. Type-2 diabetes is the most frequent complaint – when the body’s blood glucose is affected, or is unable to produce sufficient insulin to keep blood glucose levels within a healthy range. Type-2 diabetes is more common in people of Middle Eastern, North African and South/Southeast Asian backgrounds. Australian census data from 2016 has estimated 10% of adult diabetes prevalence among many Muslim Australians, who are from these ethnic backgrounds. The figure is increasing and is cause for concern.

Type-2 diabetes may hamper fasting and is potentially harmful. People with type-2 diabetes who fast but need insulin or other blood glucose-lowering medications risk blood glucose instability. Conversely, the evening meal often involves consumption of calorie-rich foods in a short space of time, which can risk high blood glucose levels overnight.

Low blood glucose levels can cause sweating, shakiness and confusion; high blood glucose levels can cause fatigue, dehydration and poor concentration. Extremely high levels are a medical emergency, as symptoms can lead to seizures, coma, or even death.

To prevent these outcomes, diet, lifestyle and medication use are key factors in maintaining stable blood glucose levels and minimising diabetes complications. Many people with type-2 diabetes can be considered medically exempt from fasting, but may feel guilty on religious grounds.

The International Diabetes Federation-Diabetes and Ramadan International Alliance (IDF-DAR) have come up with practical guidelines for physicians and their Muslim patients in regards to guilt-free fasting and diabetes management –low-risk patients can safely fast, while those at moderate-to-high risk are advised against doing so.

In addition to these guidelines, careful understanding of different cultural backgrounds, lifestyles and religious practices is crucial to avoid poor diagnoses and disengagement with health services. Culturally-appropriate diabetes education and prevention programs are evidenced to facilitate communication and patient trust. Measures that could be taken include:

• Formation of a diabetes health care team (GPs, endocrinologists, diabetes educators, dietitians and diabetes nurse practitioners) can develop an individualised Ramadan-specific management plan;
• GPs mayliaise with local religious leaders;
• Constant glucose monitoring, nutrition, exercise and potential medication changes can ensure safety for those who still wish to fast.

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