Slides meant for public/ patient education on this important topic. Presented this in many forums, TV channels and have written articles based on this

1. "Can a Diabetic Fast in Ramazan:
Who, When & How?".
Dr. Ammar Raza
MBBS, DPH, Dip. Diabeto, MBA
Diabetes Care Physician
Pharmaceutical Physician
Hon. Executive Director, Board of Directors, IK Hospital

2. Content
 Background
 Diabetes: A “Big” Growing Problem
 Ramazan Fasting: Mandatory but there are
exemptions
 Four Big Questions for a person with
Diabetes
1. Who can fast? Who shouldn’t fast?
2. How to go about? What precautions to take?
3. What about diet control/ Dietary recommendations?
4. What changes in medications? What about blood tests
etc.?

3. Fasting…. The Holy Book says
“O you who believe fasting is
prescribed to you as it was
prescribed to those before you
so that you can learn Taqwa"
(Quran Surah Baqarah 2:183)

4. Ramazan: The Holy Month

5. Voluntary
No selective
food intake
No total calorie
malnutrition
• Exercise self discipline
• Psychological effect
• Additional prayers
Uniqueness of Islamic Fasting

6. Fasting + Diabetes = Good? Bad?? or
Ugly???
 Wajib - part of ‘Furoadeen’
There are exemptions
 Medical Benefits + +
 Psychological benefits +
 Teaches self restrain
 Brings discipline
 Feel for ‘have nots’
Sugar Complaint
Common Disease
Increasing ‘now’
Health risks involved
No Cure
Needs close monitoring
Very complicated disease
+
Fasting in Ramazan Diabetes Mellitus

7. What is Diabetes?
Group of longstanding derangement characterized by high blood
sugar levels (hyperglycemia) resulting from defects in:
 Insulin secretion- Less insulin
 Insulin action- Lack of effect of insulin or
 Both
Chronic high blood sugar levels of diabetes are associated with
long-term damage, dysfunction and failure of various organs,
especially:
 Eyes
 Kidneys
 Nerves
 Heart
 Blood vessels
American Diabetes Association [ADA] – 1997
D I A B E T E S

8. 9
Diabetes: An Ancient Disease with a Rich Past
Susruta
6th century BC
Aretaeus
120-200 AD980-1037 AD
Ebers Papyrus
1550 BC

9. Explosion of Diabetes
 A common disease NOW a days
 No. of people affected is increasing at an alarming
pace world-over
 Increase is more predominately seen in countries
like India
 Can affect any individual including Muslim men or
women
 Basically, there are 2 types of diabetes: Type 1 &
Type 2
 Type 2 diabetes is more common & affects mostly overweight
people; now occurs even in young individuals in 20s & 30s
 Can be treated with tablets +/- insulin, in addition to diet control &
regular exercise

10. Diabetes: A Big Global Problem
Bigger local problem
11
IDF Atlas 20152
415
million
642
million
2015 2040
Now
THEN 2000 2030
171
million
366
million
Wild S et al 20041
NOW
32
million
79
million
2000 2030
THEN
1. Wild S et al. Diabetes Care 2004; 2. Diabetes Atlas 7th Edition http://www.diabetesatlas.org/ (last accessed 05 Mar 2017)
No. of people with Diabetes
2015 2040
69.2
million
123.5
million
2015: 1 in 11 adults have diabetes
2040: 1 in 10 will have diabetes
Every 6 sec a person dies from diabetes (5.0 mio deaths)
The Indian Express-28-Feb-2017

11. Reader’sDigest,Nov2008
Young Face of India?
Young Face of
Diabetes in India ?

12. Mohan V et al. Indian J Med Res 2007; 125:217-230
India: “Diabetes is EVERYWHERE”

13. Fasting: Helps in a no. of ways
 Fasting during the holy month of
Ramazan provides an opportunity to
all of us to
 adapt a healthy lifestyle
 teaches us disciple
 self-restraint and control

14. Fasting: Medical Benefits (1/2)
 Medical literature suggests that
there are medical benefits of
fasting during Ramadan
 Medical benefits are never the
sole reason for taking up fasting,
they are secondary in nature
 Fasting in general has been used
by patients for weight
management, to rest the digestive
system and for lowering amount of
fat in the body.
Seen only in those who maintain appropriate diets
Said 1400 yrs ago

15. Fasting: Medical Benefits (2/2)
 According to medical research from across the
globe:
 Can help lower blood sugar levels
 Can lower the amount of cholesterol (fat) in the body
 Possible lowering of blood pressure (BP)
 May help lower weight (1-3 kgs); in diabetics this benefit
may or may not be seen.
 Provides psychological benefits - peace and tranquility for
those who fast; Personal hostility reaches minimum levels
and the crime rates are reduced
Seen only in those who maintain appropriate diets

16. Diabetic Wishes to Fast…..4 Key
Questions…
Who can fast & who
shouldn’t?
1.
What precautions
to take?
2.
What about
medications -
what
modifications are
reqd.?
3.
Are there any special dietary
recommendations?
4.

17. High Risk
(Advised not to fast)
 Type 1 diabetes (children; dependent on insulin)
 If one uses insulin injections >2 times a day
 If sugar is poorly controlled
 Problems with frequent low blood sugar levels
 If one has had a hospital admission within the last 6
m for v. high blood sugar levels or v. low blood sugar
 Problems with kidneys, liver, heart or poor vision
 If there is an acute illness, incl. a diabetic foot
infection or foot ulcer
 If a woman is pregnant
Moderate Risk
Do not fast unless your doctor agrees)
 If sugar is moderately controlled and there are no
major complications of diabetes
 Well-controlled diabetes on certain tablets
Low Risk
(Can fast with advice)
 Diabetes controlled with diet
 Diabetes well controlled with certain tablets, like
Metformin, Sitaglipin, Linagliptin, Pioglitazone and
Dapagliflozin, as well as injections like Liraglutide
Who Can Fast & Who shouldn’t?

18. Who Can Fast & Who shouldn’t?
 There are indications that fasting will
no way worsen health of an individual
 Experts recommend that those who
are suffering from severe diseases
 diabetes (esp. if uncontrolled)
 heart disease
 kidney stones
 Pregnant Women
are exempt from fasting & should not try to
fast

19. Among Diabetics who can’t fast?
Do not usually follow medical advise
Diabetes + other illnesses e.g. high &
uncontrolled BP, heart ailments, infection
Who have already experienced either high or low sugar more
than one time during fasting
Wide fluctuations in blood sugar levels
Poorly controlled sugar (BS >250 mg)
Pregnant women with diabetes

20. Diabetes & Fasting: What precautions
to take?
 Patient with the help of his doctor should change his
medication to suit his eating patterns (as he skips lunch).
 A consultation with your doctor 1-2 weeks before Ramadan may
be necessary to take a decision on whether to fast or not.
 Overeating at Sehri and Iftar are to be avoided - remember
that fasting benefits appear only in patients who maintain their
appropriate diets
 Excess fat & rich foods should be avoided
 Overexertion or rigorous exercise should be avoided during
the period of fasting but it is strongly recommended that those
with diabetes continue their usual (routine) physical activity
especially during non-fasting periods
 Regular testing of blood sugars is important before the sunset
meal and three hours afterwards and also before Sehri.

21. What are the major risks associated
with fasting in diabetes?
Low blood sugar
High blood sugar
Sudden illness or complication
(DKA)
Less water & clotting of blood
(dehydration & thrombosis)

22. Do’s Don’ts
Pre Ramadhan consultation with a specialist doctor & assessment is
important; International guidelines: all diabetic patients need
assessment of suitability for fasting at least 1-2 m before Ramadan
Do not overeat at Sehri & Iftar (remember that Ramadan fasting
benefits appear only in patients who maintain appropriate
diets). Eating a balanced diet is important.
Certain changes in medication to suit changed eating patterns - done
only on the advice of a doctor.
Always take your diabetes medications
Do not consume excess fat and rich foods.
Any signs of low sugar (e.g. dizziness, sweating, trembling and
shaking, tingling of the lips, feeling hungry, going pale and increased
heart beat), if they show up, should be recognized early and patient
must seek medical advice at the earliest possible.
Do not avoid sehri especially if the duration of fasting is longer
Regular testing of blood sugars is important. Blood glucose should
be checked especially when symptoms of low sugar occur and in
case of sickness (e.g., has a fever)
Do not forget to drink plenty of fluids (including water)
between Iftar and Sehri esp. during summer months.
Eat sugary foods in moderation Do not fast if you are unwell
A consultation with the doctor immediately after conclusion of the
fasting month is important to adjust medicines and re start therapy
like before Ramadan.
Do not overexert or do rigorous exercise during the period of
fasting - strongly recommended that those with diabetes
continue their usual (routine) physical activity esp. during non-
fasting periods
√
If Diabetic fasts: What are the Dos &
don’ts?

23. Do’s: Critical Triangle
Diet Control
Change in Medication Frequent Monitoring
Follow Drs. Advice
+/-

24. Pre-Ramadan medical
assessment and counselling
 All diabetic patients wishing to fast
should receive counselling 1 to 2
months before the onset of fasting
 Medical assessment
 Educational Counselling
+

25. Quran recommends….
What about Diet in Ramazan?
 “Eat of the good things We have
provided for your sustenance, but
commit no excess therein."
[Holy Qur’an (20:81)]
Ta Ha 20: 81

26. Nutrition in Ramazan
 50 to 60% maintain body weight while
20 to 25% gain or loose weight
 Maintain healthy diet
 Eat complex carbohydrate advised at
seher meal more simple
carbohydrates at iftar
 Avoid food high in fat and sugar
Tips:
Avoid: Sweets, Samosa, Soft Drinks, Ice Cream, Fried foods, Bakery Items
Eat LOT of vegetable (except potato, beetroot etc.); Some fruits in moderate quantity

27. Diet Control during Ramazan
 Too much emphasis on preparation of food
& a greater variety and quantity of food
consumed than in other times
 There is no need to consume excess food at
iftar or saher
 A balanced diet - less than the normal amount of food
intake is sufficient to keep a person healthy and active
 Eat a wide variety of foods
 put extra effort into including foods from all the food
groups
Tips:
DON’T SKIP Saher

29. Exercise
 Normal level of exercise should
be maintained
 Extreme physical activity should
be avoided before sunset
Tips:
 Walk after Iftar
 Avoid Exercise in the middle of the day (esp. afternoons/evenings)

30. Breaking the Fast
 Patients should break fast if blood
glucose < 60 mg/dL
 If < 70 mg/dl in first few hours after the
start of fasting especially if on insulin or
sulfonylureas
 If blood glucose >300 mg/dl
 Avoid fasting on sick days

31. When in Trouble…
 The moment patient is in trouble do
not bide for time –must break fast
immediately since heroic acts of
misplaced piety have nothing to do
with the teachings of Islam

32. Injecting during fasting????
 Question– Is it permissible to inject a needle and
the nutrient during the state of fasting?
 Answer– Injecting a medicine or other via a needle
in a muscle or the jugular vein does not invalidate
the fast. Similarly using liquid drops in the ear or
the eye does not invalidate the fast even if it
caused an appearance of colour or taste in the
mouth. Also the fast is not invalidated by using the
spray that facilitates the respiratory process if the
substance goes in the wind wipe and not the food
pipe
www.sistani.org

33. Good couplet
 WHEN YOU WERE BORN, EVERYONE WAS SMILING, BUT
YOU WERE CRYING.
 LIVE SUCH A LIFE THAT WHEN YOU DEPART, EVERYONE IS
WEEPING BUT YOU ARE SMILING
Sa’di of Shiraz (d. 1292)
 

34. Articles
Further Reading, please visit the following website
http://www.almahdicentre.com/article3.html
http://www.imamreza.net/eng/imamreza.php?id=5331
www.fiqajafaria.com
www.alhassanian.com
The Message Monthly Vol. 6, No. 2, Zehra (s.a)
Academy
http://ijtihadnet.com/safe-fast-ramadan-diabetics/

35. June 2017
Will also be published in http://www.diabeteshealth.co.in/
http://www.jafariobserver.com/english.pdf

36. Have a Blessed Ramazan
 Thanks!
 Questions & Answers
 Iltemaas - e - Dua

37. My Beloved Father
Late Syed Karrar Hussain Baaqri
Please Read Sura-e- Fateha for Isal of