8th August, 2012
PUTRAJAYA: About 20.8 per cent, or around five million Malaysians, suffer from diabetes, of which one-third are Muslims, the 2011 National Health and Morbidity survey has revealed.
The Islamic religion requires all Muslims to fast from dawn to dusk during the holy month of Ramadan, and this poses a serious risk to the health of diabetics, as they tend to manage their blood sugar by eating meals at regular intervals.
But it has been observed that diabetic Muslims can still fast by exercising care.
Dr Masni Mohamad, an endocrinologist working at the Putrajaya Hospital, pointed out that verse 185 of the Surah Al-Baqarah in the Quran states that those undertaking a long journey (musafir) and those who are sick are exempted from fasting.
“Thus diabetics get an exemption as they fall under the latter category,” Dr Masni said.
This flexibility is termed as ‘rukhsah’ in Arabic and signifies Allah’s compassion for his vicegerents who are unable to fast.
Unfit diabetics should not force themselves to fast, as they are also allowed to swap fasting days for when they are feeling healthier.
Dr Masni said that diabetics should be well aware of the inherent risks involved in fasting, which can lead to two common complications, namely a Hyperglycemia or a Hypoglycemia coma.
Hyperglycemia coma is a condition where blood glucose levels become elevated and its symptoms include frequent urination, thirst, lethargy, migraine and nausea. Diabetics with this condition can slip into a coma if they fail to seek medical attention, Dr Masni noted.
A hypoglycemia coma occurs when a person’s glucose levels plunges, and its initial symptoms include perspiration, hunger, blurred vision, body chills and at times shivers. Palpitation, a fast pulse rate, migraine and nausea are some of the other symptoms manifested in this condition.
A hypoglycemic person can also tend to become aggressive and, if not treated, this condition can also force a person to slip into a coma.
As diabetics also suffer from frequent dehydration, they are advised to drink at least 1.5 liters of water a day after breaking fast.
Dr Masni added that diabetics who display these symptoms should immediately break their fast as any attempt to resume fasting can lead to life threatening complications.
Diabetics should consume a complete meal with appropriate portions before they begin their fast, and should break their fast on time.
“Those being medicated or taking insulin should consult their doctor and devise a suitable diet for the fasting period,” Dr Masni said.
Also, diabetics on insulin medication should check their blood glucose levels at least four times a day. They should do so once before commencing their fast and once after breaking fast. Glucose levels should further be checked three to four hours after the fasting begins and at a similar time interval after fasting concludes.
Dr Mohamad said a diabetic should stop fasting immediately as soon as he starts noticing any symptoms related to Hyperglycemia, wherein glucose levels go beyond 16 mmol/l.
Similar action needs to be taken if blood glucose levels drop below 3.5 mmol/l or at any time after fasting begins and if levels drop to 3.9 mmol/l, despite having injected insulin before fasting began.
Discontinuing the fast under such conditions is crucial to avoid endangering oneself as the fasting period can stretch up to 14 hours.
Dr Masni also suggested that diabetics should perform light to moderate physical exercise to remain fit.
“The Tarawih prayer, which involves prostrations and standing, is a good form of exercise, especially for diabetics. Studies have indicated that it helps strengthen the joints as well as metabolise the glucose,” he added.
Dr Masni, however, pointed out that not all diabetics should fast.
If they still want to go ahead and do it, they will only endanger themselves, which is not something that Islam allows.
Those suffering from uncontrolled diabetes, those advised by their doctors to avoid fasting and those with serious complications, such as an unstable heart and hypertension, should not fast, he said.
Diabetics with a history of Hypoglycemia coma and Ketoacidosis diabetic coma (caused due to excessive fat metabolism where the body is unable to utilise its glucose) should also not fast.
Apart from diabetics, persons with infections, pregnant women, children under the age of 12 years, those undergoing dialysis, and persons of advanced age who live alone are not advisable to fast.
“Fiber rich foods such as bread, maize, cereals, wheat and brown rice should be consumed while fasting as the body absorbs its energy slowly from these foods. These foods also provide energy continuously to the body,” Dr Masni said.
Fasts should be broken by consuming foods with high carbohydrate levels like bread and white rice.
However, diabetics are not encouraged to over indulge in food when breaking fast.
“Food that is absorbed quickly by the body helps replace the energy lost through fasting,” he added.
Dates are a good source of energy as they are rich in potassium. But diabetics are not encouraged to over indulge in them. Taking two dates should suffice.
Diabetics should also avoid oily and fatty foods and not smoke.
Water should be consumed in generous quantities to prevent constipation and low blood pressure. Diabetic patients should also be encouraged to drink fruit juices.
In general, there should not be a big difference in dietary restrictions observed by diabetics during Ramadan and in normal everyday living.
“Ramadan offers a great opportunity to reduce body weight for those suffering from obesity,” added Dr Masni.
He also advised Muslims to keep a check on their food intake and observe discipline while taking medication during Hari Raya.
“After making all these effort to observe Ramadan, don’t spoil everything when Syawal arrives,” he joked.