How medication management can help you fast safely this Ramadan
Muslims with diabetes risk both high and low blood sugar
As Ramadan begins, health experts say practising Muslims who go on a month of spiritual fasting may need to adjust their medications.
Ramadan, which falls on the ninth month of the Islamic calendar, is a holy time for Muslims around the world. From sundown on March 22 until sunrise on April 20 observers deepen their relationship with God through, prayer, reflection and charity.
They also abstain from food, drink, sex, smoking and oral medications between sunrise and sundown. There can be internal and external pressure to participate in all aspects of Ramadan — even if exceptions can be made for health reasons, said Wasem Alsabbagh, a pharmacist in Kitchener, Ont.
"Fasting is very dear to Muslims," said Alsabbagh. "My mother is 70 years old, she has diabetes and still she insists on fasting."
Alsabbagh said he and his mom sit down and go over how to fast safely, which is particularly important for diabetics.
"If you're not eating much, your medications might cause you low blood sugar, so the timing of dosing has to be changed. Sometimes the dose has to be changed as well," said Alsabbagh.
"And when she feels the symptoms of low blood sugar, I make sure to tell her it's probably time to break your fast — it is not safe for you."
Research out of the American University of Beirut in Lebanon in 2001 indicates the vast majority of diabetic Muslims surveyed do fast — despite the chonically ill being exempt.
Researchers surveyed 12,914 Muslims with diabetes. Of them, 86 per cent with Type 2 diabetes engaged in fasting and 43 per cent of Muslim patients with Type 1 diabetes participated in fasting.
With those factors in mind, the Kitchener Downtown Community Health Centre held workshops leading up to Ramadan on healthy eating, diabetes and fasting.
Danielle Simko, the registered dietitian who ran the workshops, agreed low blood sugar is a concern, but so is high blood sugar following iftar — the celebratory late-evening meal that breaks the fast and is typically rich in calories and fluids.
"When we have gatherings with friends with family, we're having delicious foods with a big spread. Often there does tend to be carbohydrate-rich foods, sweets and desserts, and things like that," said Simko. "So just acknowledging that it's OK to be somewhat selective and enjoying those foods in moderation and mindfully."
Long-acting formulas, injections
Diabetes, hypertension and migraine are chronic conditions Alsabbagh highlighted in a 2017 research paper that encouraged other pharmacists and health professionals to initiate these conversations with their patients.
But, he said, all fasting Muslims should talk to their pharmacist or doctor before or during the first week of Ramadan.
"You have to make sure it's safe for you and if there are any changes that should be done to your health-care plan or regime."
He said that along with changes to the timing of oral medications, other modifications may include:
- Switching from a pill taken several times a day to one that is longer acting.
- Switching from medication that is orally ingested, which breaks the fast, to an injection, inhalation, suppository or eye/ear drop.
He added some people — due to age, pregnancy or breastfeeding — may be required to avoid fasting during Ramadan. In some cases, he recommended moving the fast to later in the year or focusing on other elements of Ramadan, such as charitable giving.
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With files from Kate Bueckert