This is my individual perspective on fasting during Ramadan and how I use existing tools to help me follow this pillar of my faith. Your ability to fast in Ramadan is highly individual and depends on many factors. Fasting during Ramadan is a serious decision and one that every person with diabetes needs to make in consultation with their care team.
All over the world, Muslims observe the month of Ramadan by fasting from dawn until sunset. The number of hours you fast depends on where you live, since daylight hours may vary. Like all things related to food, fasting is significantly more complicated when you live with type 1 diabetes. Despite this being one of the five pillars of our faith, Muslims facing any additional hardship (like pregnancy or medical conditions) are exempt from fasting.
It is a big milestone when a child fasts for the first time, and an even bigger one when they keep their fasts for the entire month. Though they aren’t required to fast until they hit puberty, many children try to keep their first fast between the ages of 7-10. I was 8 years old when I was diagnosed with type 1 diabetes. I was still figuring out carb exchanges and adjusting to the strict eating schedule required by NPH and Regular insulin, and everyone I knew insisted that I was exempt from even trying to participate in this pillar of our faith. I didn’t get to experience the excitement of waking up before dawn with all the grownups to eat Sehri (the meal before beginning your fast), and I didn’t get to feel the joy and pride of sharing Iftar (the meal to break your fast with) after a full fast.
Ramadan is a magical time for practicing Muslims because fasting and keeping away from our physical needs is a form of spiritual cleansing. Ramadan brings out the best in people as we focus on prayer, charity, and gratitude. As I got older, I tried fasting multiple times. Some years were easier than others due to the variables around the length of the day, phase of life and all the additional challenges that come along with diabetes. Many years, my Ramadan looked like giving up TV and coffee for the month instead. Over those years, diabetes therapy also saw many advances, pushing the needle on the ‘normalcy’ a person with diabetes could live their lives with. The meters and needles got smaller and faster, analogue insulin was developed, insulin pumps, continuous glucose monitors, and most recently AID systems all emerged as therapy options. But something was still missing to allow me to safely put my body through the physiological rigors of fasting for an entire month. I still felt left out, being unable to participate in this pillar of my faith.
For me, my diabetes, and my fast, I need a set of diabetes tools that can be customized to my insulin needs and easily adjusted on a weekly basis. As my body adjusted to the routines of the fast, my diabetes behaved much differently from the first week to the last. I have found success in making these precise changes, given the tools and technology available to me, and while it has not been easy, it has most certainly been worth it.
Last year I used the Tidepool Mobile app to tag the different types of food I was having for Sehri and Iftar, how I bolused for it and what therapy adjustments I was making. This year, I can review those tags and notes to see what I did in the first week of Ramadan compared to the last which required completely different types of settings as my body adjusted to the routines of the month. I also have a reference from last year to allow me to adjust to that caffeine spike post Ramadan. So now I am prepared for the waves of changes through the month and have baseline data to start with this Ramadan.
Learning from my previous Ramadan experiences also shows me what is possible for the coming years. It helps me feel that sense of fulfillment and accomplishment that I didn’t have as a child. Without even knowing my particular circumstances, Tidepool has been creating the tools to allow my data to become more meaningful and in turn become actionable for me to make meaningful changes. Regardless of what this next month of fasting looks like, I will forever be grateful for the hope and confidence that these tools have given me to take back parts of my life that were stolen by diabetes.
For the record, my husband also has type 1 diabetes, as do both my children. He does not fast because it wreaks havoc on his blood sugars, and we believe that Allah would not want us to hurt our bodies. My children will choose what they want to do, because this choice is a spiritual one that no one else can make for you.
For any fellow Muslims reading this, my personal choice is to partake in Ramadan the best I can, hope that Allah will accept my intentions even if I have to treat a few lows during the day, and still pay my Fidya for the entire month. Just in case.
Here are some key terms and resources for future reference:
Ramadan: Ninth month in the Islamic Calendar (a lunar calendar).
Sehri: the meal before starting your fast at dawn.
Iftar: the meal you break your fast with at sunset.
Fidya: a religious donation of money or food to help those in need when a fast cannot be observed.
IDF Diabetes and Ramadan Guide: https://www.idf.org/our-activities/education/diabetes-and-ramadan/healthcare-professionals.html