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Fasting during Ramadan should have a potentially beneficial effect with regard to diabetic control.
Ramadan is a month of self-regulation and self-training, with the hope that this training will last beyond the end of Ramadan. If the lessons learnt during Ramadan, whether in terms of dietary intake or righteousness, are carried on after Ramadan, it is beneficial for one’s entire life. Moreover, the type of food taken during Ramadan does not have any selective criteria of crash diets such as those which are protein only or fruit only type diets. Everything that is permissible is taken in moderate quantities.
Diabetes Mellitus and Ramadan Fasting
Diabetes mellitus affects people of all faiths. Muslims are no exception. Many diabetic Muslims have a desire to fast during the month of Ramadan, although if they cannot for health reasons, they have a valid exemption. The dilemma for physicians and Muslim scholars is whether or not Muslim diabetic patients (1) should be allowed to fast if they decide to; (2) can fast safely; (3) can be helped to fast if they decide to; (4) can have their disease monitored at home; and (5) are going to derive any benefit or harm to their health. Fasting during Ramadan by a Muslim diabetic patient is only a privilege to be allowed by his physician, at the patient’s request, knowing all the dangers and assuming full responsibility in dietary compliance and glucose monitoring, with good communication between the physician and the patient.
Psychological State of Diabetes during Ramadan
Diabetes mellitus itself adversely affects patients’ psychological states by changes in glucose metabolism, blood and CSF osmolality, needs for discipline and compliance, fear of long term complications and threat of hypoglycemic attacks and the possibility of dehydration and coma.
On the other hand, fasting during Ramadan has a tranquilizing effect on the mind, producing inner peace and decrease in anger and hostility. Fasting Muslims realise that manifestations of anger may take away the blessings of fasting or even nullify them. Diabetics know that stress increases the blood glucose by increasing the catecholamine level and any tool to lower the stress; ie., bio-feedback or relaxation improves diabetic control. Thus, Islamic fasting during Ramadan should have a potentially beneficial effect with regard to diabetic control.
Educational Program for Diabetics during Ramadan
It should be directed towards (a) diabetic home management (b) preparing them for Ramadan (c) recognising warning symptoms of dehydration, hypoglycemia and other possible complications.
Patients should be taught home glucose monitoring, checking urine for acetone, doing daily weights, calorie-controlled diabetic diet, need for sleep and normal exercise. They should be able to take pulse, temperature, look for skin infection and notice changes in the sensorium (mental alertness). They should be on special alert for any colicky pain, a sign for renal colic, or hyperventilation, a sign of dehydration, and to be able to seek medical help quickly rather than wait for the next day.
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