How Diabetics Handle Fasting for the Muslim Holy Month of Ramadan

PHOTO: Patients wait for their checkups at Jordans National Center for Diabetes in Amman, Jordan, June 14, 2015.Khaled Al Odat/AP Photo
Patients wait for their checkups at Jordan's National Center for Diabetes in Amman, Jordan, June 14, 2015. The center is particularly busy ahead of the Muslim holy month of Ramadan when diabetics seek advice on whether they can observe the sunrise-to-sundown Ramadan fast.

As more than a billion Muslims begin the observation this week of the holy month of Ramadan, Wael Mousfar will be among them.

Mousfar, 62, is a Type 2 diabetic, so marking the holy month with the customary fasting during daylight can play havoc with his blood sugar and insulin levels. But Mousfar said he’s not worried.

“I will be fasting for sure,” he told ABC News. “I’ve been doing it all my all life. I would not stop during Ramadan, the fast.”

Mousfar, of New York City, has been a diabetic for over 20 years, but said his diabetes hasn’t stopped him from observing Ramadan.

“I really look at fasting as [spiritual,]” Mousfar said. “It’s body and soul work together.”

PHOTO: A nurse takes blood from a patient at Jordans National Center for Diabetes in Amman, Jordan, June 14, 2015.Khaled Al Odat/AP Photo
A nurse takes blood from a patient at Jordan's National Center for Diabetes in Amman, Jordan, June 14, 2015.

In previous years, Mousfar said his doctor found that he lost weight and had better blood sugar following the fast. But even in his own family fasting for Ramadan can cause problems. His brother, also a diabetic, has had his blood sugar drop below safe levels during Ramadan and ended up breaking the fast as a result, he said.

At the Islamic Center of America in Dearborn, Michigan, Executive Administrator Kassem Allie said diabetes has become a growing concern in the local community. Those who have a medical issue such as diabetes or pregnancy are allowed to break the fast for their health, but Allie said some try to adhere to the rituals anyway.

“People are disappointed they can’t fast,” Allie said of those with diabetes. “Some people hesitate to go to the doctor because they say I can’t fast. They try it for a couple days and see how you do.”

He explained that many people are reluctant to give up the rituals around Ramadan, including the big meal enjoyed at sunset with family and friends.

“They fast for 25 and 30 years and suddenly they develop this malady,” said Allie. “Fasting becomes a way of life and it’s a traditional [and] communal.”

Diabetes has been steadily rising in the Middle East and North Africa -- areas with a high population of Muslims, according to the Associated Press. In the U.S., about 9.3 percent of the population have diabetes.

Lisa Cimperman, a dietitian at University Hospitals Case Medical Center, said it’s unlikely that people with Type 1 diabetes can safely fast due to the sensitive nature of their condition. She said those with Type 2 diabetes -- once known as adult-onset diabetes -- could likely just “flip” their schedule so that their normal daytime schedule of calibrated pills and carbohydrates is changed to night so that their blood sugar level remains stable.

“This would definitely be a time for even individuals with Type 2 diabetes to check their blood sugar regularly throughout the day,” said Cimperman, who explained many people with Type 2 diabetes don’t have to check their blood sugar multiple times daily.

“That will be the best way to see how their body is reacting to fasting,” she said.

PHOTO: Shawkat al-Khalili, a 70-year-old diabetic, is examined by Dr. Nayef Khalayla at Jordans National Center for Diabetes in Amman, Jordan on June 14, 2015.Khaled Al Odat/AP Photo
Shawkat al-Khalili, a 70-year-old diabetic, is examined by Dr. Nayef Khalayla at Jordan's National Center for Diabetes in Amman, Jordan on June 14, 2015.

Linda Jaber, a professor of pharmacology at Wayne State University in Detroit, has studied diabetes in the Muslim community for years and explained that aside from the daytime effects, diabetics can face problems as they break their fast at night.

“The traditional meal where you break your fast is rich in carbs and low in fat. It’s calorie intense and people tend to overeat,” she said. “A high blood sugar level after you break fast is also a complication.”

While Mousfar said he is ready to start the fast this week, he also noted that he will not have a problem giving up the fast in the future if his health is at stake.

“If I feel that my body is in danger [that] I had to stop, then I don’t hesitate to do it,” he said of stopping his Ramadan fast. “[The] dangerous part is if someone breaks it on purpose and they don’t need to break it.”