Fasting & Diabetes Mellitus [Archives:2000/49/Health]

Mahfouth A Bamashmus
University of Science & Technology, Sanaa
Several of the worlds great religions recommend a period of fasting or abstinence from certain foods. Of these, the Islamic fast, during the Muslim month of Ramadan is strictly observed every year. The experience of fasting is intended to teach Muslims self-discipline and self-restraint and remind them of the plight of the impoverished. Muslims observing the fast are required to abstain not only from eating and drinking, but also from consuming oral medications and intravenous nutritional fluids.
Fasting extends each day from dawn until dusk, a period, which varies by geographical location and season. In summer months and northern latitudes, the fast can last up to 18 hours or more. Islam recommends that fasting Muslims, eat a meal before dawn called sahur. Individuals are exempted from Ramadan fasting, if they are suffering from an illness that could be adversely affected by fasting. They are allowed to refrain from fasting for one day or the whole month, depending on the condition of their illness. People diagnosed with diabetes fall into this category and are exempt from the fasting requirement.
Physicians working in Muslim countries and communities commonly face the difficult task of advising diabetic patients whether it is safe to fast, as well as recommending the dietary and drug regimens diabetics should follow if they decide to fast. To judge correctly, whether to grant medical permission to fast to a diabetic patient, it is essential that physicians have an appreciation of the effect of Ramadan fasting on the pathophysiology of diabetes mellitus (IDDM=Insulin dependent diabetes mellitus; NIDDM=Non-insulin dependent diabetes mellitus).
Recommendations During Ramadan Fasting
1. Nutrition and Ramadan fasting:
It has been emphasized that Ramadan fasting benefits appear only in patients who maintain their appropriate diets. Thus, in order to optimize control, diabetics must be reminded to abstain from the high-calorie and highly refined foods prepared during this month.
2. Physical activity and Ramadan fasting:
Several studies indicate that light to moderate regular exercise during Ramadan fasting is harmless for NIDDM patients. It should be impressed upon the diabetic patients that it is necessary to continue their usual physical activity especially during non-fasting periods.
3. Drug regimens for IDDM patients:
Some experienced physicians conclude Ramadan fasting is safe for IDDM patients with proper self-monitoring and close professional supervision.
4. Drug regimens for NIDDM patients:
With proper changes in the dosage of drugs, there will be low risk for hypoglycemia and hyperglycemia.
5.Education about warning symptoms of dehydration, hypoglycemia and hyperglycemia. Education about breaking fast as soon as any complication or new harmful condition occurs.
6.Immediate medical help for diabetics who need medical help quickly, rather than waiting for medical assistance the next day.
Fasting during the entire month of Ramadan is reserved usually for healthy Muslims. However, many diabetic patients are allowed to fast periodically during Ramadan. The bulk of literature indicates that fasting in Ramadan is safe for the majority of diabetic patients with proper education and diabetic management. Most NIDDM patients can fast safely during Ramadan. Occasional IDDM patients who insist on fasting during Ramadan can also fast if they are carefully managed. Strict attention to diet control, daily activity and drug regimen adjustment is essential for successful Ramadan fasting.
Reference:
International Journal of Ramadan Fasting Research

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