Dr. Raeesa Moolla continues with Chronic illness and fasting in Ramadaan…
We very often see diabetic patients who are concerned whether they can fast or not. These patients should visit their doctor at least 1 month before Ramadhaan. A glycated hemoglobin test to check for control in the past 2-3 months should be done and these patients should be made aware of the symptoms of low glucose levels and the importance of compliance with diet and medication. Checking blood sugar levels with a pin prick will not break the fast but will break wudhu. There are different groups of diabetic patients.
Group 1: On diet alone to control diabetes.
These patients can fast without any risk. In fact fasting is good for them to control blood sugar. Avoid sweet and rich desserts and soft drinks. Check glucose levels before Suhur, before Iftaar and before bedtime.
Group 2: Diet and oral medication.
Thay can fast under strict supervision of their doctor; as long as glucose control is good. Some types of medication dosages may have to be decreased or at times altered according to the patient’s normal regime.
Group 3: Those on insulin.
Generally should not fast. If they can manage and do fast it has to be under strict supervision where new dosages have to be worked out with their doctor.
Asthma sufferers need to have their asthma under control well before Ramdhaan as the inhalers (asthma pumps) and nebulizers cannot be used while fasting. They can take their medication at Suhur and Iftaar. However if a patient gets an acute attack and need his reliever pump then the fast must be broken and a qadhaa kept.
The usage of nasal drops/ sprays is not allowed while fasting. So think about this before you fast if you have a severe post-nasal drip or cold.
This is not a contradiction to fasting. It is interesting to note that blood pressure falls slightly during Ramdhaan. Most medication are usually taken once or twice a day. No changes need to be made to these dosages. However if a person is on diuretics (water tablets) than these must be taken at Iftaar rather than Suhur. People who have to take diuretics more than once a day i.e those with moderate to severe heart failure should not fast.
With good control the person may fast. In severe cases especially when a three times a day dosages is required then the patient should not fast.
If a patient has a healed ulcer or a history of a peptic ulcer and is currently controlled he can fast.
Contra Indication to fasting:
1. Active ulcer on endoscopy
2. Intractable pain and back pain
3. Presently vomiting blood or dark stool
4. Past history of perforation and still symptomatic
5. Pyloric obstruction
6. Symptomatic patient with previous ulcer surgery
Medical examinations during fasting
Internal vaginal or rectal examinations are not permissible. If a person is ill and requires urgent examination then he should stop fasting and qadhaa will have be observed for that particular fast. Pessaries and suppositories (and tampons) are also not allowed.
A pregnant woman who is keen to fast should seek the advice of a knowledgeable doctor. Generally it is advised not to fast in the 1st and 3rd trimester. If the woman is strong, healthy and has no obstetric complications she can fast. If she is concerned that the fasting can be harmful to herself or the foetus then she should not fast.
Those with severe symptoms eg nausea, vomiting, heartburn should not fast. If any evidence of intra uterine growth retardation then she must not fast.
If a lactating woman has fear that her milk will dry up while fasting then she should not fast.
Many women choose to postpone their period by using contraceptive pills.
For women who are already using oral contraceptives. It is a simple matter of omitting the placebo pills and start another pack of pills.
For those not on OCD: they need to commence the pill on the 1st day of Ramadhaan.
For those who don’t want to take the OCD: they can use progesterone provided they have a regular cycle. She can commence therapy 2-3 days prior to the onset of her menstruation and continue till the end of Ramadhaan. The dose is three times a day and the can be taken at Suhur, iftaar and bed time or twice a daily Suhur and Iftaar, but the chance of break through bleeding with this is quicker.
The above are commonly encountered conditions.
This article only serves as a general guideline. If you have a medical condition, it is best to seek the advice of your doctor.
1. Ramadhaan- A complete Guide
2. Health Guidelines for Ramadhaan – Dr F Haffejee