(Interfaith America) — Nafeesunnisa Syed, a resident of Palos Hills, Illinois, had been prone to exhaustion, dizziness and frequent fainting spells ever since she was diagnosed with Type II diabetes in 1994. Despite her symptoms, she continued to fast during Ramadan — a sacred month for Muslims that involves abstaining from food, water and intimacy from sunrise to sunset for 29 to 30 days and is obligatory for all healthy Muslims who have reached puberty. 

Syed consulted her doctors to take medication to manage her disease, but she felt she could continue fasting. But in 2010, she fainted again at a friend’s dinner party and was rushed to the emergency room, where doctors informed her that she had nearly missed a stroke due to low blood pressure. Alarmed, her family intervened, and asked her to stop fasting. She hasn’t fasted since.  

“I pray, I read the Quran more often, I give charity, I try to do all the other things I’d normally do with my family during Ramadan that brings me peace,” says Syed. 

Syed is not alone in her journey. According to the International Diabetes Federation, there are over 150 million Muslims with diabetes worldwide. To raise awareness about the risks associated with diabetes, and to optimize the care delivered to people with diabetes who plan to fast during Ramadan, in 2016 the International Diabetes Federation collaborated with Diabetes and Ramadan International Alliance — a volunteer group of hundreds of doctors, nurses, educators, diabetic patients and their families, and religious scholars of diverse faiths from Europe, Middle East, South Asia, North America, and other regions. 

Together, they created a series of guidelines for the management of diabetes during Ramadan. Experts say more medical professionals need to pay attention to this valuable resource. 

A qualitative medical study published by PLOS ONE states that many diabetic Muslims choose to fast against medical advice during Ramadan, potentially increasing their risk of acute complications, and most do not receive pre-Ramadan diabetes education on fasting safely, including information on potential dose adjustments of glucose-lowering medication. Some patients said they did not discuss fasting for Ramadan with their healthcare providers due to a lack of cross-cultural understanding and communication, and the doctor’s inadequate knowledge and understanding of the significance of Ramadan for Muslims.  

Addressing these gaps, the guidelines, available in six languages, are divided into two categories: for healthcare professionals, highlighting Ramadan-focused diabetes education, and for diabetic patients, offering tips on assessing risk levels, monitoring blood glucose, knowing when to stop fasting, and adjusting medications during fasting. As of 2021, the guidelines have been downloaded over 45,000 times across the world.  

“The guidelines will empower healthcare professionals to be more proactive, to know what advice to give patients fasting for their religious beliefs, and how that impacts their health,” says Dr. Mohamed Hassanein, Chair of the Diabetes and Ramadan International Alliance, and Senior Consultant at Endocrinology Dubai Hospital in Dubai.  

He adds, “As for people with diabetes across the globe, we see many of them taking the risk [of fasting]. It’s like anything in life, how many smokers continue to smoke when they know that it can cause problems? How many people take risks of maybe not using the seatbelt when they’re driving or drive a bit faster than they should? So human beings take risks anyhow. But it needs to be an informed [risk].” 

In addition to the guidelines, the Diabetes and Ramadan Alliance also offers other resources like DAR Academy — an online application that enables healthcare professionals to attend lectures, download updated resources, and use the “risk calculator’” — a tool that measures 14 distinct aspects of a patient’s health and circumstances and sorts them into three categories: green (low risk of fasting), amber (moderate risk), and red (high risk).   

“Doctors tell me this has lifted a weight off their shoulders and unified their approach to treating their patients who seek advice on whether to fast or not,” says Hassanein.  

To make informed decisions while delivering care to their patients, Hassanein believes it’s important for healthcare professionals to have diverse religious literacy. His desire to form the Alliance was not just rooted in the need to bridge the gap in knowledge around Ramadan and diabetes, but also rooted in his Islamic beliefs.  

“Islam does not advocate anything that harms the body at all,” says Hassanein. “While fasting during Ramadan is obligatory for healthy adults, it includes in the same verse the exemption for people who are ill, traveling, pregnant, breastfeeding, among other reasons.”  

According to Islamic scholars, people who need to break their fast for a day due to illness or travel, can make-up for it by fasting another day. Others can do fidyaa religious donation paid by individuals who cannot fulfill the obligation of fasting due to illness or old age. Fidya payments are meant to feed a miskeen (person in need) for each of the fasting days missed. 

Though the reception to the guidelines has been positive, its adaptation by healthcare workers has been slow, especially in North America.  

Dr. Luma Ghalib, an endocrinology expert from Columbus, Ohio, is one of the hundreds of endocrinologists Hassanein reached out to in the U.S. to help spread the word about the guidelines. Ghalib believes the limited exposure practicing physicians in the U.S. have to literacy around diabetes and Ramadan contributes to the slow adaptation of the guidelines.  

“There are some published guidelines by the American Diabetes Association) … there are some limited [resources] out there that physicians have been using,” says Ghalib. “But the DAR Alliance [guidelines] are more advanced and have hands-on day to day instructions for the physician taking care of diabetic patients. Our goal is to make them more readily available.” 

The American Diabetes Association recommendations for management of diabetes was first published in 2005, and Hassanein was one of the contributing authors. It was last updated in 2010 to include the effects of prolonged fasting for those who have to fast over 18 hours during longer months in the summer.  

Ghalib has been attending medical conferences, webinars, and endocrinological societies across the U.S. to raise awareness about the guidelines and the importance of religious literacy for healthcare workers.  

“Having awareness of religious or non-religious minority groups and their different practices, health issues, risk factors, language barriers, and just being aware that there are people doing things differently than the general majority will improve how we provide healthcare to them,” says Ghalib.  

But it’s not just the healthcare workers who need to be more aware, Ghalib has advice for diabetic patients too, to be more informed about their choices and what they need to do to continue fasting while taking care of their health.  

“Trust your physicians – the lack of trust is a big gap. A lot of minorities unfortunately don’t trust their healthcare systems, due to previous experiences and misunderstandings, but have good faith in your physicians, they’re trying to help you,” says Ghalib. “And speak up, if you’re not sure, ask questions until they listen to you. The third piece of advice is to not wait until the last minute. If you’re planning to fast … having an action plan ahead of time is the best thing you can have.”  

Both Ghalib and Hassanein hope the Diabetes and Ramadan guidelines will help not only Muslims, but any diabetic patients who are fasting for religious practices like Lent, Yom Kippur, Tisha B’av, Fast of Esther, or non-religious purposes, like intermittent fasting.  

“Fasting is not about Muslims, it’s about flexibility in lifestyle and respect for different people’s views, cultures, habits and religion,” says Hassanein. “The risks of fasting could be with someone who’s not religious at all, but for some reason, they may have not had any food or drink for that particular day. So having that understanding of what sort of measures I need to take is important.”  

As for Syed, the diabetic patient from Illinois, she believes these guidelines will be helpful not just to strengthen doctor-patient relationships but will also help other Muslims understand and be less judgmental of diabetic Muslims who cannot fast during Ramadan.

This story was published in partnership with Interfaith America, a website of Interfaith Youth Core.

This content was originally published here.