Last year, I had the opportunity to share my personal perspective and experience with fasting during Ramadan with type 1 diabetes. This year, we wanted to check in with other members of the community to see how they participate in Ramadan while also doing the work of an organ to manage blood sugars. This is a mini blog series that will include the perspectives of different members of the community that celebrate Ramadan in their own way - because we know there is no one size fits all approach to anything related to diabetes.
Key terms that will be used throughout this series include:
- Sehri/Suhoor: the pre-dawn meal before starting your fast.
- Iftar: the meal you break your fast with at sunset.
- Eid - a day of celebration at the end of Ramadan.
- Fidya: a religious donation of money or food to help those in need when a fast cannot be observed.
For this part of the blog series, we checked in with Sarah Aleem, a friend of ours from the diabetes community who was diagnosed with type 1 diabetes when she was 14 years old. We are so grateful to Sarah for sharing how she spends Ramadan since her diagnosis!
My first Ramadan post diagnosis, my doctor predictably told me not to fast. To be fair, at that point I was struggling on MDI (multiple daily injections) with an A1c that needed work. The addition of fasting to all the other variables while managing blood glucose levels was a lot for a teenager. But I most clearly remember feeling like I wasn’t meeting my religious expectations, and frankly, just left out if I didn’t fast. I felt like I couldn't credibly share my 'Ramadan spirit' without fasting, especially as my siblings were able to go to school and teach their friends and peers about Ramadan through their personal experience of fasting.
Luckily, my mom imparted advice that I still hold with me today. She reminded me that while I may have to sit out of fasting for a very special month of the year, my type 1 diabetes diagnosis actually causes me to “fast” every single day of the year by managing my blood glucose levels and helping my body stay healthy and nourished.
There’s no Eid from diabetes!
Ramadan is and should be a personal experience for every Muslim, with or without diabetes or any other health considerations. What other people think about how I choose to spend this holy month should have no role in my decisions because it is solely between me and Allah. Allah has made concessions for those with health concerns because fasting shouldn’t be unfairly difficult or put you in harm’s way. For example, women do not fast while on their periods or pregnant, and people may be excused from their fast if they suffer from migraines. Instead, Allah gives Muslims who aren’t able to fast the option of paying ‘fidya.” In lieu of fasting, we can pay money for those in need to eat.
I am now in my 30s and have learned more about how to manage my blood sugars, and switched over to an insulin pump and continuous glucose monitor (“CGM”) which has offered me more flexibility. Instead of fully opting out of Ramadan, I take every Ramadan on a case by case basis with no definitive intention about whether or not I am going to fast that year. I use the first few days of Ramadan to see how my body adapts to help frame myself for the rest of the month.
Even if I might not drop too low during the day, the post-iftar spikes sometimes seem impossible to get control over, spending the whole night making up for it - and then don’t feel good the next day. So I give myself another day or two to play around with my basal rates and what I eat at iftar. Depending on how it is going, I may decide to only fast on the weekends. Sometimes, like during the long days of summer where both days and nights were too hard to manage my blood sugar, I will focus on a new goal: staying in range 90% of the time or some other non-fasting related goal or objective. My approach is very flexible and fluid with no parameters (or guilt!) on whether I should or shouldn’t fast - it is about recognizing whether it is working for my body and my health at this particular time or not, which is also a religious obligation.
In the last two years since the pandemic started and we haven’t been able to participate in community events - I have tried to be cognizant of the spirit of Islam and the month of Ramadan throughout the day, which makes me feel like I am a part of the community effort and what makes the month so special. My way of participating in this month just looks a little different than the average Muslim. I try to make a diabetes related goal - Time in Range has been my primary objective ever since the Dexcom CGM came into my life.
The holy month of Ramadan is spiritual and fasting from food and yes, even water, is only one part of it.
What I have learned over the years is that you have to make space for yourself - and not feel guilty if fasting isn’t in the cards for you this month. I shouldn’t feel forced to do it, especially if it isn’t right for my body. Nobody else, including your doctor, knows your body the way you do. You have agency over your body and know what you can and cannot do. You know your own thresholds. Try not to feel guilty about how your version of participating in Ramadan might look different - and know that Allah has given us the flexibility within our religion. There are so many ways to be a good practicing Muslim during Ramadan that do not involve fasting. We have a tall order to keep our bodies healthy and that is also a part of our religious obligation - know that Allah does not want us to hurt the bodies he has gifted us with. Don’t feel guilty about what your Ramadan looks like, don’t compare to anyone else - just do what you can.