The Muslim Council of Britain and Diabetes UK got together and put out a pamphlet for diabetics who plan to fast for Ramadan. It’s a little better in some ways than the NHS advice, but it’s still not good. It nowhere says you just shouldn’t fast if you have diabetes, period. It nowhere says you shouldn’t fast if you have diabetes and you don’t have to. It nowhere says fasting is optional.
It opens with
If you are planning on fasting and have diabetes, it is important to speak to
your diabetes healthcare team as early as possible before Ramadan. For some
people with diabetes, fasting can be dangerous or can cause problems to your
health. Your diabetes team will be able to advise you on whether it is safe for
you to fast. If you are able to fast, they will advise you on how to keep good
diabetes control throughout the fasting period.
That’s not good enough. It puts planning to fast first, and it shouldn’t. It should start with: If you have diabetes, you shouldn’t fast.
It doesn’t come right out and just say you shouldn’t fast. It mentions the risks but in a timid, non-urgent way.
From 2014, for the next several years Ramadan
in the UK is in the summer months and the length of
fasts is very long (17 hours +). Long fasts put you at
higher risk of hypoglycaemia and dehydration, which
can make you ill.
High blood glucose levels can also occur if you eat
excessively at Suhoor or Iftar.
So don’t do it. That’s a good reason not to do it, so just don’t do it. If you must do it, if you insist on doing it, here’s some advice, but you shouldn’t do it…they never say.
When we don’t eat during a fast, at about eight
hours after our last meal our bodies start to use
energy stores to keep our blood glucose (sugar)
levels normal. For most people, this is not harmful.
With diabetes, especially if you take certain tablets
or insulin, you are at risk of hypoglycaemia or
‘hypos’ (low blood glucose levels). This year, the
fasts are long and the risks of hypoglycaemia and
dehydration (lack of water) are high. Another
problem that can occur if you have diabetes, is
the risk of high glucose levels following the
larger meals that we eat before and after fasting
(at Suhoor/Sehri and Iftar).
Hypoglycaemia, high glucose levels and dehydration
can be dangerous for people with diabetes.
So people should not do it – but the pamphlet never says that.
I HAVE DIABETES
– CAN I FAST?Most people with health problems, such as diabetes
are exempt from fasting. Choosing to fast is a personal
decision that you should make with advice from your
diabetes team. For some people with diabetes, fasting
can be dangerous or cause problems to your health.
Speak to your GP, diabetes nurse or diabetes
doctor before fasting.
That’s the closest they get to really warning people – that bold type saying speak to someone first. But still, they don’t say you just shouldn’t, they don’t say it’s a risk not worth taking, they don’t say you don’t have to.
They never say you don’t have to. Just: you don’t have to, period. On the contrary they imply that you do have to, unless you’re “exempt.” After the bold type they go on to:
Certain people and circumstances are exempt from
fasting. For example:
• children (under the age of puberty)
• the elderly
• those who are sick or have a certain
health condition
• those with learning difficulties
• those who are travelling
• pregnant, breastfeeding and menstruating women
• anyone who would be putting their health at serious
risk by fasting, eg people who treat their diabetes
with insulin and/or certain medication, people who
have diabetic complications (damage to eyes,
kidney or the nerves in your hands and feet), or
people who have poor control of their diabetes
Saying that some people are “exempt” implies that everyone else is required. What is this “exempt” nonsense anyway? Says who? By what authority? According to what? I know, it’s one of the 5 pillars, but why is that being treated as the equivalent of actual law? Everyone is fucking “exempt” from fasting at Ramadan.
Remember, if you cannot fast, you can complete
your duties by offering charity or providing food to the
poor. Speak to your local Imam for more information
about this.
Remember, if you cannot fast this Ramadan,
you may be able to make up the fast at a later date,
perhaps during the winter months.
You must speak to your doctor or diabetes nurse
about your diabetes treatment as early as possible
before Ramadan.
It’s better than nothing, but it’s miles from as good as “you don’t have to at all, and you shouldn’t – it’s too dangerous and too hard on your body.”
Then there’s a rather sad question, “Do I need to wake up for Suhoor?” And the relentless answer.
Long hours without eating increase the risk
of hypoglycaemia. You must try to eat a meal
at Suhoor just before sunrise and not at midnight,
as this will help to keep your glucose levels more
balanced through the fast.
In other words yes, you have to ruin your sleep by waking up at 3 a.m. to eat for the last time before 11 p.m.
At the end there are safety tips, which is good, but also bad, because the risk shouldn’t be undertaken.
Always carry glucose treatment with you.
• Always have diabetes identification, such
as a medical bracelet.
• Test your blood regularly to monitor your
glucose (sugar) levels. This will not break
your fast.
• Test your blood glucose level if you feel
unwell during the fast.
• If your blood sugar level is high or low,
you must treat this.
• If your blood glucose is less than 3.3mmol/l,
end the fast immediately and treat the low
blood sugar level.
• If your blood glucose level is 3.9mmol/l at
the start of the fast and you are on insulin
or gliclazide, do not fast.
• If your blood glucose level is higher than
16mmol/l, end the fast immediately.
• If you become dehydrated, end the fast
immediately and have a drink of water.
• If you start to feel unwell, disoriented,
confused, if you collapse or faint,
stop fasting and have a drink of water
or other fluid.
• You should never stop your insulin,
but you must speak to your doctor
because you may need to change the
dose and times of your insulin injections.
It’s so obviously not at all the right thing for diabetics to do. The pamphlet should say that clearly and say that you don’t have to. In plain English. Not “you may be exempt” but “you don’t have to in the first place.”
The reality is, this will make a whole lot of people sicker than they would otherwise be, all for a religious fast that’s treated as somehow mandatory. That’s a horrible, anti-human, pointless situation.
I shouldn’t say this.
I hate to say this.
But I feel compelled to say this.
Darwin Awards.
Implicitly prefacing the whole thing “If you choose to follow the rules of Islam, …” is, I guess, a given with a leaflet about how to do Ramadan correctly. After all, why would you want to know whether you “have” to fast if you don’t care for religious customs and rules in the first place? I guess the answer’s a “yes” for anyone who’d refer to a Muslim Council pamphlet for advice anyway, but an explicit mention would be nice (and on the NHS version, a must).
And considering that even after a “yes”, the rules explicitly include a clear set of “not if it would harm your health” exceptions, I don’t see why their advice is not just to stick to them, as in: “You’re sick, that’s covered in this exemption, so follow the rules by doing the charity thing instead of fasting.”
My thoughts exactly. You don’t even have to go outside the orthodox rules of Islam itself to do this. Just recognize that diabetes is a disease where the regularity of your diet is of great importance and give a blanket exemption on that basis.
Of course, commitment to the group is increased when people have to sacrifice something to follow the rules; basically a kind of sunk cost fallacy. Conversely, the more you’re committed, the more you’re willing to sacrifice and the more you think other people should, too. So, these things have an odd way of escalating.
“Speak to your GP, diabetes nurse or diabetes doctor before fasting.”
Then ignore their advice, and the Koranic instructions, because Islam…
The enormously high levels of diabetes in the Muslim world are especially at issue. I had seen that Saudi Arabia and the Gulf States had the highest rates of diabetes in the world. A previous note here on B&F mentioned south Asians having six time the rate of diabetes of the world as a whole.
Sedentary living and obesity have been named factors for the Arab states. That wouldn’t seem reasonable for Asians. Has anyone studied the issue across the genetic/social/religious zones?
One wonders how many other critical meds don’t get taken correctly at Ramadan because they need to be taken with water or some other lubricant. Lithium for example……