FASTING is compulsory for all healthy, responsible and sane Muslims. Certain Muslims are either exempted or not recommended to fast. They include children under the age of puberty, those with learning difficulties and unable to understand what it means to fast, the elderly and frail, and those suffering an acute illness or longstanding medical condition where fasting may be detrimental to their health. There are numerous health benefits of fasting ranging from weight loss, an improved diet and an abstinence
of smoking while fasting. Diabetes mellitus is one of the most important medical conditions affected by fasting. The condition is
a major health problem and globally almost 400 million people are affected. It is well known that many diabetic patients fast during Ramadaan, despite the Qur’an exempting the sick from fasting. This is often attributable to their high spiritual state and strong
Islamic beliefs. However, the medical recommendation is that all diabetic patients should consult their doctor if they want to fast because fasting may pose risks, including hypoglycaemia (low blood sugar), hyperglycemia (high blood sugar), diabetic ketoacidosis, dehydration and thrombosis. A medical assessment is particularly important and should include a full annual medical review, detection of complications relating to diabetes, measurement of blood pressure and important blood tests such as the blood cholesterol,
HBa1C and kidney function tests. It is important to involve the patient and his/her family in this discussion. Matters to be discussed include awareness and monitoring of low and high blood sugar, planning of meals, monitoring of blood sugar levels, physical activity and an emergency action plan. Patients and their families should be counselled regarding what must be done when an acute complication occurs and when patients should break their fast. It is also prudent for patients taking diabetes medication (such as metformin, a suphonylurea such as gliclazide, or insulin) to discuss their medication with their doctor, for possible dose adjustments to be instituted. It is not recommended for highrisk diabetic patients to fast. Patients in this category include those with type 1 diabetes or heart or kidney problems, recent or recurrent episodes of a hypoglycaemia, pregnancy, and being acutely unwell. It is very important for these patients to consult with their doctors. While fasting presents an opportunity to improve one’s diet, many people unfortunately tend to overeat during Ramadaan (especially at night). This is not in keeping with the ethos and philosophy of this holy month and certainly not recommended by medical professionals. It would be desirable for patients with diabetes mellitus, hypertension or any other chronic medical condition to consult a dietitian before observing the fast. The general recommendations for diabetic
patients include avoiding food high in fat and sugar, consuming a complicated carbohydrate at dawn and a simple carbohydrate at dusk. Slow energy release foods such as grain, wheat and rice tend to be best before and after a period of fasting. Taraweeh prayers along with possibly walking to mosque represents opportunities to remain physically active during Ramadaan. While the
recommendation is to maintain normal levels of physical activity during the day, excessive exercise, may result in hypoglycaemia and should be avoided. However, this may be difficult if someone has a very labour intensive job. Observing Ramadaan is alive and well in Cape Town and while many children are already fasting at the time of puberty, several are “initiated” a bit earlier.
Parents may often start this process through having their children fast from dusk until breakfast, then lunch and gradually increase
the length of fasting until the child is able to fast a full day at the time of puberty.
Dr Nasief van der Schyff is Head of Department of medicine and the diabetic clinic at Victoria Hospital, and specialist physician and senior lecturer at UCT.
Dr Julian Trokis: Diabetologist – Dabetes Care Centre (Cape Gate Medical Centre).