Most of the world’s great, recognized, and accepted 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. Islam specifically outlines one full month of fasting from sunrise to sunset. The experience of fasting is intended to teach Muslims self-discipline and self-restraint, and reminds 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 or use of intravenous nutritional fluids.
The month of Ramadan covers a period of 28 to 30 days. The dates of observance differ each year because Ramadan is set to a lunar calendar. Fasting extends each day from dawn until sunset, a period that 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, called “Sahar”, before dawn.
Individuals are exempt from Ramadan fasting if they are suffering from an illness that could be adversely affected by fasting. They are allowed to abstain from fasting for one day to all 30 days, depending on the condition of their illness. People diagnosed as diabetes fall into this category and, although they are exempted from fasting, they prefer to fast and often loathe not being able to observe Ramadan. Physicians working in Muslim countries and communities commonly face the difficult task of advising diabetic patients on the
safety of fasting as well as recommending the dietary and drug regimens diabetics should follow if they decide to fast. The lack of adequate literature on this subject makes it difficult to answer these questions. To judge correctly whether to medically permit a diabetic to fast, it is essential for physicians to have an in-depth understanding of the effect of Ramadan fasting on the pathophysiology of diabetes mellitus.
