A challenging fast?

Muslims with diabetes in the UK could be putting their own future health at risk during the holy month of Ramadan, by observing fast and not informing their doctor of their dietary choice.

A study by the universities of Manchester and Keele published in the journal "Health Expectations" found that some Muslim diabetes patients chose not to tell their GPs or practice nurses that they were fasting.

"Some of them were afraid of going to talk to their doctor or nurse about how to manage their diabetes during Ramadan, mainly because they were afraid of being told not to fast," doctor Neesha Patel, the lead author of the report, told DW.

"They also thought that even if they tried to talk to their doctor or nurse, they may not understand the significance of Ramadan."

The Quran allows for exemptions

Muslims are asked to fast during daylight hours in the month of Ramadan, which this year runs for 30 days from 28 or 29 June (depending on your time zone). Yet the Quran says Muslims can be exempt from the fast under certain circumstances.

"In the Quran it says that you are exempt from fasting if you are travelling, if you are sick or if you're a female and having your menstrual cycle," explained Dr Patel.

Yet some of the respondents in her study said they did not consider diabetes to be an illness, leaving them with no choice than to follow their religious duty.

Fasting can mean poor control of a patient's diabetes and can lead to dehydration. In the longer term it could seriously reduce quality of life and increase mortality. The study's authors are calling for better information to the Muslim population as well as more training for healthcare personnel.

"Our study shows the importance of considering patient experiences, especially when forming guidelines in this area and suggests a need for better training for GPs and practice nurses and with Mosques and community leaders," said Professor Carolyn Chew-Graham, co-author of the report.

Uphill struggle

British Muslim community leaders recognize the problem, and many say they are working actively to address it every year when Ramadan comes around. But it is, at times, an uphill struggle.

"So many times I've visited patients in the month of Ramadan and they have a very, very valid excuse not to fast," Imam Saddiq Diwan at a Manchester mosque told DW.

"Because they've been fasting for 20, 30 years and never missed a fast, you can understand where they're coming from. With tears streaming down their eyes they'll say 'Imam, look, I've never missed a fast, and now I have to miss a fast?' So therefore they feel that guilt."

Imam Diwan works closely with healthcare professionals and advises his congregation to heed existing medical advice. He also tells them how the Quran allows concessions for people who are ill.

"You should not feel that you have been religiously compromised. The Prophet has said - peace be upon him - that Allah loves those who take the concessions he does give you. So take the concession and don't fast - that would be our advice," said Imam Diwan.

Fasting not impossible

Recent figures suggest approximately 325,000 Muslims have diabetes in the UK. The condition is up to six times more common in the South Asian population and four times more common in the Bangladeshi and Pakistani groups than in the general UK population.

Reaching patients with the correct advice is therefore important, not least because some diabetes sufferers could manage to observe fast, or parts of it, as long as they know how to manage their condition.

"Patients who've had a complication with their diabetes in the previous three months, those patients need to be exempt," said Kate Jones, a nurse practitioner at a GP clinic in Salford, near Manchester.

"But for patients who have been well we can look at changing their treatment for a little while, teaching patients to be checking their blood pressure and how to eat at the times they can eat - in the darkness. The only thing that is really missing is education," she said.

Yet as Dr Neesha Patel's study shows, that education is what is often missing, because the patients will not seek it out. The charity Diabetes UK is working with both health professionals and community leaders to improve the situation.

"It is concerning that this research suggests that some Muslims feel uncomfortable in talking about their fasting decisions with their doctor or practice nurse, and we need to send out the message that everyone with diabetes who is considering fasting throughout Ramadan should speak to their doctor, practice nurse and their Imam, who can help people come to the decision that is right for them," said Jenne Patel, Diabetes UK's Equality and Diversity Manager.