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Fasting And Diabetes


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Those suffering from type 2 diabetes may be worried about observing the fast during the Muslim month of Ramadan. However, it is possible to fast safely if you are careful about managing your diabetes.


A recently study concludes that most people with well-controlled type 2 diabetes can safely observe the fast. The study was published in the July 2008 issue of Clinical and Experimental Hypertension.


Nevertheless, it is important for those with diabetes to take care, since some drugs that are used to treat type 2 diabetes, such as sulphonylureas and insulin, can make your blood glucose level drop too low when you are not eating. Not drinking enough water can also make you dehydrated.


Often the evening meal, iftar, contains lots of carbs and perhaps sugary drinks. Because this is a time when families eat together to break the fast, the food may be richer than what you might normally eat. And having fasted all day, you may feel you have an excuse to reward yourself, but you need to be particularly strong willed at this time!


Fasting checklist:

  • Seek the advice of your healthcare team before starting and at the end of the fast, since they may advise you to change the frequency or amount of medication you take.
  • Do not stop taking your medication, however the dosing and timing of your medication may need to change – this should be discussed with your diabetes healthcare team prior to fasting.
  • If you experience symptoms of low blood sugar levels such as sweating, anxiety, shaking, weakness or confusion then you should break your fast with a sugary drink followed by foods rich in carbohydrates.
  • Avoid eating lots of unhealthy foods as a reward! Instead, try and maintain a healthy eating pattern after you break the fast.
  • Make sure that you have lots of fruit and vegetables and dhal as these are slowly digested and help your blood glucose to rise more slowly too. Also remember to drink plenty of fluids.
  • Divide your daily food intake into two equal portions, one to be taken at sehri and one at iftar.
  • Be sure to check your glucose level regularly — at least once a day at different times of the day.


Following Ramadan, visit your doctor to make sure that your blood glucose is being controlled adequately, and also to check whether your medication needs to be adjusted.

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Q: Is it permissible for a diabetic to take an insulin injection whilst fasting and will it nullify the fast?


A: Taking an insulin injection whilst fasting is permissible. The insulin does not nullify the fast. However, in the case where the insulin is directly injected into the stomach the fast will be nullified.

والمفطر إنما هو الداخل من المنافذ (رد المحتار على در المختار ج2 ص395)

وما وصل إلى الجوف أو إلى الدماغ من المخارق الأصلية كالأنف والأذن والدبر بأن استعط أو احتقن أو أقطر في أذنه فوصل إلى الجوف أو إلى الدماغ فسد صومه (بدائع الصنائع ج2 ص93)

Answered by:

Mufti Zakaria Makada

Checked & Approved:

Mufti Ebrahim Salejee (Isipingo Beach)

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Diabetes and fasting


In the name of Allah, the most Beneficent, the most Merciful.


Firstly, using an injection does not break ones fast.  Therefore, if the diabetic patient can fast throughout the day by using the insulin injection then this will not render ones fast invalid.

(Ahsanul Fatawa p.432 v.4)


However, if you need to consume solid foods every few hours and have to forgo the fasts in Ramadhan, then one should keep them at another time during the year, maybe during the shorter days.  Consult with a Muslim doctor if there is some way to retain enough insulin through certain diets through the duration of the fast.


If this is not possible then you are considered incapable of fasting and thus it will be permissible for you to forgo your fasts and pay fidyah instead.  (Maraqi Falah p.453)


The fidyah for each fast is similar to how much one gives for sadqah fitr.  This is to give 1.6 kg of wheat or 3.2 kg of barley or the equivalent of the above in cash (£2 – £3).  (Raddul Muhtar p.532 v.2)


It must be remembered if the patient somehow becomes capable of fasting again, all the missed fasts will have to be made up again, even if you have already paid fidyah for them.  (Fatawa Hindiyyah p.207 v.1)


Only Allah Knows Best

Mohammed Tosir Miah

Darul Ifta Birmingham

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Diabetes and missing fasts during Ramadan Qibla.com


Answered by Shaykh Abdurrahman ibn Yusuf Mangera


I am diabetic and can not fast due to this medical condition. During fasting after one P.M., my blood sugar level goes down and I experience sever headaches followed by vomiting. This is permanent situation. Can I pay fidyah every year and if so how much I have to pay.




Assalamu alaykum

In the name of Allah, the Inspirer of truth.


Type 1 diabetes is a serious problem. If this problem has been diagnosed in you and has been established in a concrete way, through consultation with an expert physician or diabetes specialist, then you will do the following:


If you have to forgo the fast in Ramadan but can keep them at another timeduring the year maybe in more shorter days of the year, then you have to make them up in those days that you feel better. Consult with a Muslim physician if there is some way to retain enough insulin through certain diets, medicine, etc. through the duration of the fast (especially nowadays when fasts are so short) and keep them.


Added note: Obviously with the prevalence of diabetes this is a commonly raised concern. There are two important issues in this matter (along with what has already been mentioned above).


First, it is medically important that one distinguish between type I and type II diabetes. Second, before looking to exemptions in the shariah one with such problems should contact a Muslim physician who understands the importance of fasting. Such a physician can often come up with an altered insulin regimen for the periods of fasting. In most cases this issue can be resolved at this level


2. If this is not possible and the problem of headaches and vomiting remain a serious problem at all times (even after working with a new regimen of medicine and insulin), then you are considered a person incapable of fasting due to terminal weakness or illness. It is permissible for you to forgo your fasts and pay fidya instead (Tahtawi alal-Maraqi 453). It must be remembered though that in any case, if you somehow become capable of fasting again (even through advanced medicines or treatments), all the missed fasts will have to made up again, even if you had already paid fidya for them (Fatwa Hindiyya 1:207).



Abdurrahman ibn Yusuf


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Can My Sister Pay Expiatory Payments (fidya) For Missed Fasts Due To Her Diabetes?


Question: My sister-in-law has been diagnosed with diabetes and advised by her doctor not to fast. Does she have to fast? How much expiation does she have to pay if she cannot?


Answer: I pray this finds you in the best of health and spirits.


1. It is not an “automatic” that every diabetic person is unable to fast. If you’re able to, encourage your sister-in-law to discuss her specific situation with a discerning scholar. Many doctors (fearing medical liability) err on the side of excessive caution in such matters.


2. If it is established that she is presently unable to fast, then there is no expiatory payment (fidya) for her to give, unless she is both elderly and the condition is not likely to ever improve.

[ref: Shurunbulali, Maraqi al-Falah]


And Allah alone gives success.

Faraz Rabbani


(Originally answered on the SeekersGuidance Ramadan Course Forum)

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Diabetic? Consult doctor before fasting



It has been a habit since childhood — waking up for suhoor in the wee hours of the night during the holy month of Ramadan, fasting until sunset and ending the day with a sumptuous meal at iftar. The holy month is more than a religious obligation for people like Parvez Ahmed Khan, 50, for whom it is a way of life.


So when in 2007 he was diagnosed with diabetes, he didn’t think twice about renouncing the religious practice in favour of health concerns. Although international guidelines on management of diabetes exempts diabetic patients from religious fasting, almost 50 million diabetic Muslim patients are fasting this year, as per a recent survey conducted by MSD, a global healthcare leader.


Abstaining from water and food from dusk to dawn, for more than 15 hours a day, is no mean feat for diabetic patients.


Fasting for long hours alters body processes and can severely affect blood-sugar levels in the body. Due to long gaps between food intake along with certain diabetes medications, the health risks are more pronounced for such patients.


“Fasting for long hours can lead to hypoglycemia, which is low blood sugar; or even hyperglycemia (high blood sugar) as well as dehydration and flambosis,” says Samer El-Ali, MSD’s Medical Director (Middle East & Africa). Since insulin levels fluctuate in diabetic patients, fasting aggravates the condition.”


As per the World Health Organisation, nearly five per cent of the world population is diabetic. By 2035, this number is expected to rise to 10 per cent of the total population, and diabetes is expected to be the seventh leading cause of death. Management of diabetes, therefore, is critical for the overall well-being of the global populace.


El-Ali, therefore, recommends patients to consult medical professionals at least a month or two before Ramadan begins to lower the risk associated with fasting.


“Patients should discuss their medication schedule with the physician to see if any change is required to reduce the side effects of hyperglycemia or hypoglycemia. Secondly, the blood sugar levels should be closely monitored. Patients should plan their meals, exercise and know when to break fast. This is absolutely critical to good health management,” he states.


El-Ali recommends that if the blood sugar is less than 70ml, during the first few hours after the starting of fast, or greater than 300ml, patients must break their fast immediately.


According to Dr Mohammed Belal Alshammaa, Consultant Endocrinologist at Dubai Diabetes Centre (DCC): “The most important step for any diabetic who chooses to fast is to ensure he visits a health practitioner so that the doctor can advise whether it is safe for him to fast and to gauge whether his body will be able to manage long hours of fasting. Once that is ascertained, the patient needs to modify the medication dosage — usually lower the doage — to ensure they maintain their sugar levels.”


Alshammaa also notes that self-monitoring of blood sugar is not only permitted but also essential during fasting and should be effectively utilised to avoid hypoglycaemia or hyperglycaemia, especially during the first few days of fasting. “During the first week, it is advisable to monitor the blood sugar several times a day — when the patient wakes up, before Asr prayer, before iftar, two hours after iftar and at suhoor so as to understand the pattern of their blood sugar levels and to adjust their medication if needed. If the sugar level is erratic, the patient should visit their doctor.”


Dr Fathiya Al Awadi, Head of Endocrine Unit at Dubai Hospital, adds: “Self-monitoring of sugar, timely medication and right diet are all steps that diabetics need to take since their body does not have the ability to control fluctuations in blood sugar level.


They also dehydrate faster, especially when their sugar levels rise. Therefore, they need to ensure they take sufficient precautions to maintain their sugar levels while fasting.


Diabetics who are insulin-dependent, that is primarily type 1 diabetics are considered to be high-risk groups.


We usually advise them not to fast because they are at a higher risk of developing hyperglycaemia or hypoglycaemia.


Type 2 diabetics can fast after adjusting their medication in consultation with their doctor, following all the recommendations.”


A drop or rise in the sugar level for diabetics can cause symptoms like weakness, shaking of the hands, difficulty in speech and heart palpitations.


As a precaution, all diabetics should have a fast-acting sugar source at hand such as glucose gel or tablets, fruit juice, sugar, honey or dates, to consume if they are experience low sugar.




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Good health while fasting


> Do not skip meals (suhoor/iftar) during Ramadan


> It is advisable to have a light meal at suhoor.


> A wholesome meal can include wholegrain breads, oatmeal or high-fibre cereals with one cup of low-fat or fat-free milk and one piece of fresh fruits.


> At iftar, eat slowly absorbed foods such as beans and lentils in addition to lean meat, fish or chicken, low-fat or fat-free milk or yoghurt. Consume plenty of vegetables and a serving of fresh fruit.


> Avoid high-calorie, processed and salty foods


> Limit fried and fatty foods. Measure the amount of oil used in cooking.


> Limit intake of sweets and desserts


> Drink enough water and/or sugar-free beverages between iftar and suhoor.


> Avoid overeating


> Take your medication and/or insulin as prescribed


> Avoid exercise during fasting hours; do it two hours after iftar. Tarawih prayers are considered part of the exercise programme.




Who should Not fast


> Patients who have had severe low blood glucose three months prior to Ramadan


> Patients with a history of recurrent low blood glucose


> Hypoglycemia unawareness (diabetic patients with low blood glucose who do not have any symptoms of low blood sugar and are not aware of the hypoglycemia).


> Patients who cannot control their diabetes especially those with diabetes type 1.


> Those who had diabetic ketoacidosis three months prior to Ramadan.


> Diabetic patients who are pregnant


> Diabetic patients with renal failure and/or are on dialysis




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