Fasting safely during Ramadan

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Fasting safely during Ramadan

 Prof. Muhammad Yakoob Ahmedani
Head of Ramadan Study Group

Fasting in the month of Ramadan is one of the five pillars of Islam. During Ramadan all healthy Muslims are obligated to fast. Patients with diabetes who fast during the month of Ramadan can have acute complications. Some of the major complications are hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, dehydration and thrombosis and these complications occur as a result of the decrease in food, fluid intake, and misconception to break fast, dose adjustment and lack of Ramadan Education.

Several large epidemiological studies have been performed in different parts of the world; still there is a lack of information about the standard management of diabetes in the Muslim world. It was also observed that patients did not change their drug dosage and timing and also did not actively monitor their blood sugar levels, even when they developed acute complications due to lack of awareness.

Another study observed that patients attending tertiary care centers were more aware about the components of Ramadan-specific diabetes education such as signs and symptoms of hypoglycemia and hyperglycemia, dose of medicines/insulin during Ramadan fasting, dose of medicines/insulin when not fasting, self-monitoring of blood glucose, dietary modifications, physical activity, adequate nutrition and adequate hydration during Ramadan. Through this studywe conclude that knowledge of patients at Tertiary care center was significantly better compared to patients seen at Primary care center. Education given by diabetes educators was more effective in increasing patients’ knowledge, clarifying their myths and misconceptions regarding Ramadan fasting, awareness about appropriate and timely SMBG and management of glycaemic status during Ramadan. Interestingly, emergency treatment of hypoglycemia was covered more by the physicians at Primary care center. Physicians focus mainly on acute complications of fasting without divulging into details of other aspects of Ramadan-specific patient education which may be due to time constraints.

Patients with diabetes who intend to fast should undergo Pre-Ramadan assessment and receive appropriate highly individualized patient education. Health care providers should also be educated and trained to deliver appropriate advice in order to ensure safe fasting in patients with diabetes during Ramadan and need to provide more intensive education before fasting, to disseminate guidelines, and to propose further studies assessing the impact of fasting on morbidity and mortality.  Patient’s education is identified as the cornerstone of safe fasting which is needed on both an individual and large-scale level and this is the responsibility of health care professionals involved in the care of patients with diabetes. Clear and comprehensive advice should be provided to all patients with diabetes who intend to fast during the month of Ramadan. It is suggested that Pre-Ramadan education should not only contain standard diabetes education but should also include specific advice regarding Ramadan-related issues such as the possible risk of complications during fasting, the importance of capillary blood glucose monitoring, when to break the fast, meal planning and physical activity during fasting hours.