Ramadan fast can put Muslims with diabetes at risk

For Muslims around the world, Ramadan is an intensely spiritual time – but issues around fasting are difficult to talk about for many. Photograph: Oded Balilty/AP

Tears ran down the cheeks of an elderly Asian man sitting in his hospital bed during Ramadan last year as he sought reassurance from Muslim chaplain Siddiq Diwan because he could not participate in the annual religious month-long fast.

“I know I am ill and do not have to fast, Imam,” the old man said to Diwan at Manchester Royal Infirmary. “But I have never missed one in seven decades, and I really feel bad about it.”

While this patient had reluctantly accepted that fasting was not an option for him, thousands of Muslims with diabetes in the UK go ahead regardless. Many will put themselves at risk of serious illness and dangerous complications by taking part in the Ramadan fast (beginning on 28 June) when they go without food, water and even medication between sunrise and sunset – despite the fact that the Qur’an makes exceptions for the sick, pregnant women, children and anyone for whom it would cause physical harm.

As an Imam working at the hospital, Diwan sees the Ramadan dilemma from both sides, and works to resolve issues both in local mosques and among the city’s health professionals.

He has also contributed to the UK’s first study on the beliefs and experiences of Muslims with diabetes during Ramadan, being carried out by Manchester University-based psychologist Dr Neesha Patel. The results, published in the journal Health Expectations, highlight the intense pressures felt by individuals with diabetes during the period, from family, culture, religion and their own conscience.

More than half the diabetics in Patel’s study still fasted; many continued to do so through a sense of obligation, the need to conform or a belief that the Qur’an demanded it. Some altered their own medication during the period of Ramadan – mostly without the advice of their GP or practice nurse. Some were put under family pressure to follow the fast, while others felt the need to conceal their decision not to fast by snacking in secret.

This problem will not go away on its own. Patel says: “Ramadan is an annual event – it is going to be with us forever. There is a large Muslim population in the UK and the level of diabetes in some of the communities is many times higher than in the UK generally. This is a big issue. For change to happen there needs to be government support.”

The UK has a population of 2.7 million Muslims, of whom 325,000 have diabetes. The South Asian population has six times the general rate of the condition. This year the holy month of Ramadan falls in the summer, and fasters in parts of the northern hemisphere will face periods without food or water that last up to 21 hours. These long periods of abstinence will feature for the next 10 years.

Fasting in itself can sometimes be beneficial to health and for many people Ramadan is an intensely spiritual time. But many health professionals are worried about a lack of formal guidance from Islamic as well as health leaders.

Vascular surgeon Dr Noreen Khan is a practising Muslim from north London, interested in fasting, who sees people with end-stage diabetes. She believes that diabetics with good glycaemic control can fast safely if GPs revise their medication at least a month before Ramadan, in some cases temporarily substituting longer-acting drugs.

But she says: “In the UK our scholars and theologians have not been prepared to make any rulings. Muslim scholars should give a consensus and provide all GPs with this information, so that they can give patients both medical and religious guidelines.”

GP Dr Faizan Ahmed from Moss Side Family Medical Practice in Manchester agrees there is a need for clarity. He says: “At the moment there is a social stigma in some community groups about not fasting, and the onus is very much on the individual to make a decision.”

Since 2010, his practice has invited all patients known to be Muslim for a pre-Ramadan review of their health and medication. This he described as a “watershed”, with fewer patients ending up in A&E since, and some taking the decision for the first time not to fast because of their health problems.

In the absence of national health guidelines, Diabetes UK, in collaboration with the Muslim Council of Britain, has produced culturally-sensitive material for people who want to fast, and scripts for Imams. This year the charity is sending volunteers into five largely Islamic areas during Ramadan, with the aim of reducing diabetic complications.

Maslaha – an organisation which aims to help Muslims with the dilemmas of living in a western society – has produced award-winning medical and Islamic information in partnership with Tower Hamlets primary care trust about safe fasting.

Medical training does not cover Ramadan. Trainee GP Dr Iyegbe Iredia admits that as a Catholic she was taken aback by her first patient queries about Ramadan: “I would encourage people to fast if they want to, but the advice is all a bit ad hoc at the moment. GPs need clear guidelines, and it would be good to have somewhere to send complex Muslim patients for expert advice.”

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Ramadan fast can put Muslims with diabetes at risk