Fasting is one of the five pillars of Islam and is prescribed for all Muslims. It is written in the Holy Qu'ran (Sura II; Verse 185): Ramadan is the (month)/In which was sent down/The Qur'an, as a guide/To mankind, also clear (Signs)/For guidance and judgment/(Between right and wrong).” Putting stress on fasting, the Holy Qu'ran also says: “God intends every facility/For you; He does not want/To put you to difficulties./(He wants you) to complete/The prescribed period,/And to glorify Him/In that He has guided you;/And perchance ye shall be grateful.” Ramadan is a month which is full of Allah's blessings, and Muslims do their best to observe fasts following God's command. However, there are many who suffer from illnesses and diseases and are either unable to fast or need to exercise caution while doing so. One of these is diabetes. According to the World Health Organization (WHO), Saudi Arabia is one of 10 countries that have the highest number of diabetics in the world. In fact, diabetes affects nearly 30 percent of the population in the Kingdom. Diabetes is a pancreatic disease causing the organ to produce insufficient amounts of insulin, which is an important hormone for processing glucose into glycogen. There are two types of diabetes: Diabetes Mellitus I (Type I) , which can be caused by infections of certain bacteria or viruses, exposure to food-borne toxins and feeding very young infants cow's milk; and Diabetes Mellitus II (Type II), caused by a combination of age, lack of exercise and obesity. People who have diabetes must carefully monitor their sugar consumption as this - along with stress - exacerbates the condition and increases the chance of dangerous hypoglycemic attack. In extreme cases, diabetes can cause blindness and even gangrene in extremities, such as the toes, due to the increased chances among diabetics in contracting peripheral arterial disease. Dr. Safiyul Rahman, an internist at Sameera Polyclinic in Jeddah, told Saudi Gazette that fasting in both Type I and Type II diabetes is possible, although with the supervision of the doctor. However, there are special situations regarding Type I diabetes. If the blood sugar level is not under control (i.e.causing uncontrolled Diabetes Mellitus and Diabetes Mellitus with renal problems and Diabetes Mellitus with cardiac problems, as well as diabetic ketoacidosis - complication of keton in the urine), then the diabetic may not be able to fast. As for Type II, there are three categories: diet control, diet control with oral medication, and oral medication with insulin. In the first category, the diabetic can go ahead with fasting under the supervision of the doctor with some dietic restrictions and time changes. They should avoid adopting a simple carbohydrate diet including fine sugar and fruits like mangos and bananas. Instead, they should take a complex carbohydrate diet including starchy foods like corn, barley, wheat products, and fruits. In this kind of diet, the sugar is released slowly and does not shoot up. In the diet control with oral medication category, the patient can fast in consultation with the doctor and by modifying and adjusting the dosage. In oral medication with insulin, they can fast provided they properly monitor the sugar level. They should avoid taking long-acting insulin (some insulin covers 24 hours, for instance), and instead use short-acting insulin. “During Ramadan, it is very necessary to avoid feasting after fasting (over-eating). In Ramadan, physical activities are cut down, so there is no need for this over-eating,” Dr. Rahman said. He added that during Ramadan, diabetic complications go up because people are not conscious or careful of their condition, and do not seek medical advice and guidance.According to him, they should drink more water because dehydration is not at all good for diabetics. Juices such as apple, orange, watermelon – which are low-calorie fruits – can also be taken. For those diabetics taking insulin in either types of the condition, they should be prepared to break the fast immediately if the sugar level goes down. Tell-tale symptoms are headaches, excessive sweating, giddiness, palpitations, and breathing difficulty. If any diabetic is suffering from these symptoms, they should immediately drink two spoonfuls of fine sugar mixed in 200ml of water. “Diabetics should eat more vegetables and a fiber-rich diet to avoid constipation. They should also not eat spicy and fast food so as to avoid heartburn and acidity,” Dr. Rahman said, adding “There is no need either for compete rest or heavy exercise during Ramadan. Mild to moderate exercise is fine.”
