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Concern raised over people with type 2 diabetes fasting for Ramadan in lockdown

Concern raised over people with type 2 diabetes fasting for Ramadan in lockdown

Researchers highlight the impact of lack of exercise during the Muslim holy month for people with diabetes.

Published: May 15, 2020
Category: Research

The Qur'an requires Muslims to fast from sunrise to sunset during the month of Ramadan, that began this year from around 23rd April for 29 or 30 days.

However, there are exceptions to this, for people who are ill or have medical conditions, including diabetes, who do not have to fast.

To find out more about this, you should speak to your Imam. Healthcare professionals advise that if you are showing any symptoms of Covid-19 it would be advisable not to fast.  

Professor Wasim Hanif, Professor of Diabetes and Endocrinology, Consultant Physician, and Clinical Director in Diabetes at University Hospital Birmingham, said: “I know that Ramadan is a very important time of year for Muslims around the world. This holy month will be very different this year due to the Coronavirus outbreak.  

“It is more important than ever therefore to ensure that people who are living with diabetes only fast after discussing it first with their diabetes team. Fasting can be dangerous if you have diabetes as it can cause health problems.”  

A recently published report in Diabetes Therapy by researchers at De Montfort University, Leicester has suggested that a lack of physical activity and poor sleep patterns during Ramadan could have an adverse effect on the health of people with type 2 diabetes.

Muslims around the world are observing Ramadan by taking part in a religious month of intermittent fasting that involves abstaining from food and drink from dawn to dusk.

People with type 2 diabetes should seek medical advice as to whether they take part in fasting or not.

Researchers were also concerned that the global coronavirus lockdown could lead to a dramatic fall in physical exercise compared to previous periods of Ramadan, when people were free to visit their Mosque and visit friends and families to feast after dusk.

The study was the first to measure the effects of Ramadan on sleep patterns and exercise for people with type 2 diabetes using results from exercise monitoring devices.

Dr Abdullah Alghamdi carried out the study

Study author Dr Abdullah Alghamdi carried out the research as a Faculty of Health and Life Sciences PhD student in his home country of Saudi Arabia, where he works in a healthcare centre, and recruited 16 women and 20 men with type 2 diabetes.

Each agreed to wear a Fit Bit device to measure exercise, rest and sleep while also filling in a daily physical activity questionnaire. They did this for seven days during Ramadan and then for another seven days two weeks after Ramadan had finished.

While physical activity was low in both periods – the heat is a major factor on daytime physical activity in the city of Riyadh, where the study took place – there was a significant fall in the amount of sleep people were getting during and after fasting.

It was estimated that half of the group were getting less than six hours sleep a night during Ramadan, compared to around a third more than that in the period following Ramadan.

Previous research has shown that a lack of activity and small periods of nighttime sleep can have an effect on the way the body uses insulin and glucose.

The report concluded that less physical activity and poor sleep behaviours of study participants could worsen their diabetes, in addition to minimising the potential of Ramadan intermittent fasting as a non-pharmacological therapy for managing, or even reversing, type 2 diabetes.

Dr Alghamdi said: “Under Islamic laws, people with a medical condition can be exempt from Ramadan. What I would say is anyone with type 2 diabetes should seek medical advice about whether they take part.

“Some people manage their diabetes perfectly well, but others may be putting their health at risk.”

Researchers said previously published research had shown that intermittent fasting could benefit the health of people with type 2 diabetes – but a total lack of activity could negate this.

Dr Alghamdi added: “I am also concerned, during lockdown, about the lack of physical activity people will have. Normally during Ramadan people are walking to their Mosque and then visiting friends and families after dusk to eat and socialise. This cannot happen now. So, people with type 2 diabetes must really plan to use the daily exercise time that the UK Government allows during lockdown, irrespective of if they choose to fast or not during Ramadan.”

Professor Parvez Haris of De Montfort University, Leicester

Professor Parvez Haris, study co-author, added: “This Ramadan, the combination of social isolation and inability to perform outdoor activities, or socialise with friends and families, is likely to impact the mental and physical health of everyone, including those with type 2 diabetes. To reduce these impacts, people should make an extra effort to keep in touch with families and friends through social media and telephone and engage in additional physical activities inside the house.”

Read the report in Diabetes Therapy

Guidance for people with diabetes who decide to fast during Ramadan:

If, after consulting with your doctor, you decide to fast:

  • If you are taking insulin, you will require less insulin before the start of the fast
  • The type of insulin may also need changing from your usual type
  • Pre-mixed insulin is not recommended during fasting
  • Before starting the fast, you should include more slowly absorbed food (low GI), such as basmati rice and dhal, in your meal, along with fruit and vegetables
  • Check your blood glucose levels more often than you normally would
  • When you break the fast, have only small quantities food, and avoid only eating sweet or fatty foods
  • Try to eat just before the break of dawn. When you commence the next day's fast
  • At the end of fasting you should drink plenty of sugar-free and decaffeinated fluids to avoid being dehydrated.
Read the latest guidelines and advice for Muslims fasting during the month of Ramadan from the Muslim Council of Britain
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Category: Research

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