This Is How People With Diabetes Are Observing Ramadan
From April 12 to May 12, 2021, Muslims worldwide are observing Ramadan, the ninth month of the Islamic calendar. During this month, Muslims observe Ramadan in a variety of ways including community prayer, donating money, and fasting. However, for people with diabetes, especially Type 1, fluctuating blood sugar levels can make observing the fasting element of Ramadan challenging.
“You would need to be monitoring very closely during that fasting period to make sure that blood sugars are not dropping below 70 because that can become very dangerous in a Type 1 diabetic,” Shadi Vahdat, MD, chief medical officer at the Create Cures Foundation tells Beyond Type 1. Because people with Type 1 diabetes are unable to regulate their own blood sugar levels, fasting could cause glucose levels to fall, making blood glucose management more difficult.
Mohammed Seyam, a medical student living in Gaza tells Beyond Type 1 that despite having Type 1 diabetes, he fasts completely during Ramadan. “I sleep during morning time, 5 am to noon so I just have six hours to fast. I haven’t missed any day,” Seyam explains.
Although Seyam has not broken his fast, he shares that fasting as a person with diabetes comes with a plethora of challenges. “There are no pumps in the Gaza Strip. There are no sensors,” Seyam explains, speaking of insulin pumps and continuous glucose monitoring systems (CGMs), which can help make diabetes care less burdensome. “If you want a sensor, you’d have to ship it from other countries.” Seyam recalls a conversation he had with a friend who waited over six months for a continuous glucose monitor. “I don’t know many Gazans who have pumps.” Not having access to CGM technology—in Gaza and across the world, as diabetes technology coverage ranges from non-existent to cost-prohibitive—makes Ramadan challenging because people have to monitor their blood sugar levels so closely, using a regular blood sugar testing kit and finger pricks. .
Unfortunately, like many other countries including the U.S., Seyam says that insulin affordability is also big issue, which impacts not only safety while fasting, but safety living as a person with Type 1 diabetes in general. “If you have insurance, you pay less than one dollar to get the vial.” Without insurance, Seyam explains that Gazans would have to pay 20 U.S. dollars. “It’s hard for people to buy these things because of the unemployment rates. There are no jobs.” In the third quarter of 2020, Gaza’s unemployment rate stood at 48.6 percent, according to data released by the Palestinian Central Bureau of Statistics (PCBS).
Seyam says that although Gazans with health conditions such as diabetes have permission from God to break their fast, stigma is weaved into the fold of Gaza’s social fabric. “People want to fast during Ramadan although they know it is risky for them to fast. But we will just do it because we don’t want anybody to talk about us that we did not fast. We don’t want anyone to mention us badly,” Seyam shares.
Despite the pressure to prevent a break in fasting, Seyam reminds others that people battling health conditions shouldn’t feel pressured to participate in this way. “We can break a fast because it affects our health and your health is a priority here.”
Navigating Ramadan With Diabetes
Dr. Vahdat says that fasting will affect each individual differently, depending on the type of diabetes a person has. No matter which type of diabetes a patient may have, Vahdat recommends consulting about Ramadan with an endocrinologist. “You will most likely need modification of medication, whether it’s oral, prescription medications, or insulin,” Vahdat states.
The complex interplay of diabetes knowledge and monitoring makes diabetes management more difficult to manage. “So definitely talk to your endocrinologist, regardless of what type you have.”
Vahdat also explains that Ramadan observance will differ based on geographic location. “If Ramadan falls during the summertime, it’s going to be the days are longer and the fasting period is longer. If it’s during the winter time, that fasting period is shorter,” she explains.
While there are some observed health benefits of fasting, fasting “has to be personalized, individualized, and especially for anyone with medication and serious medical concerns,” Vahdat says.
Alternative Ways To Observe Ramadan Without Fasting
Instead of fasting, Seyam says that people can donate money to people living in poverty. “For each day, there’s a specific amount of money that is determined by the Mufti,” Seyam explains. The set price of donation differs each year.
For Eritrea Mussa Khan, content creator and co-host of Diabetics Doing Things based in Texas, observing Ramadan extends beyond fasting. Eritrea says that if people with diabetes can’t participate in the fast, reading the Quran is another great way to participate. “Usually during Ramadan, we get together at the masjid or at the mosques in Dallas and Irving, where I live. My families are really a large part of the community and so we go to the masjid at nighttime,” she shares.
“There are other ways that I’m trying to practice Ramadan by being as nice as possible,” Mussa Khan says. Mussa Khan recalls when someone said something mean to her online. She replied online and later deleted the comment after reflecting on the symbolism behind Ramadan. “The purpose of Ramadan is to feel the humility of people who cannot afford to eat or drink water,” Mussa Khan explains.