Breaking the fast for type 1 diabetes during Ramadan

Amir Hosein, 22 years, lives in Yazd, Iran and he is Muslim. Amir doesn’t fast during Ramadan because it is too dangerous for his health.  In our exchange, Amir shares his experience with diabetes during the Holy Month, breaking the fast for type 1 diabetes and the support he receives from the diabetes community in Yazd. 

 What does Ramadan mean to you?

“The Holy Month” is the first word that appears on the mind of a Muslim when they hear “Ramadan”.  I live in Yazd, Iran and we use the Jalali calendar. Fasting is a big part of Ramadan, and the fast is considered to have a mystical effect on people.  We also believe it will not affect our daily work.

I live with type 1 diabetes.  Based on the laws of Islam, any ‘matter’ that enters my body after the Fajr As-Sadeq will break my “fast” in Ramadan because I must inject basal insulin.  This prevents me from fasting.  I don’t like breaking the fast, but I have to for my health.

Because I can’t fast for Ramadan, I often feel like an alien in my country.

Some of my Muslim friends with type 1 diabetes will fast this month because of the spiritual and mystical effects. They do this by trying to control their blood glucose. I think they must have more enthusiasm than me. Of course, one day – I will try to catch up to them!  I think most Muslims with type 1 diabetes who can’t fast in Ramadan, have a similar feeling.

Many Muslims (perhaps in other countries) believe that injecting insulin doesn’t break the fast. Medical guidelines also put this idea forward. Why do you believe?

Injection during Ramadan depends on the reasoning of my Marja taqlid in Shia or Mufti in Sunni.  Of course, most people say that intramuscular injection won’t break my fast in Ramadan but others have different reasoning.  There are many different belief systems. Individuals must choose.  Essentially, I can’t fast because of the risk of hypoglycaemia, not because of injection.

What do you eat after the sunset?  Do you drink water?

I am not fasting, so I drink a lot of water. I have kidney stones, so I try to drink at least 8 glasses of water a day. For mealtimes, I eat Tahini and bread like taftoon and kopok, sangak, or lavash but these types of bread are common in my diet.  Sometimes I eat bread with cheese, or with tzatziki and shouli are common in my meal at sunset

Have you ever become unwell or experienced very high blood sugars or very low blood sugars during Ramadan?

My HbA1cs have all been under 6.5% since I was diagnosed. In the chart below you can see the graph of my HbA1cs. The first was three months after diagnosis (6.3%) and the last A1C is for 2.5 months ago (5.8%).  I was diagnosed 5 years ago on February 20, 2014.

I have never fasted during Ramadan but some of my friends with type 1 diabetes have fasted.  Mostly, they had high blood glucose (about 300mg/dl) so they couldn’t continue their fast.

When and why did you get started in diabetes advocacy?

I started by sharing my blood glucose on Instagram and created an Iranian public diabetes page.  Some type 1 teenagers don’t like letting others know they have diabetes, so I created this page and share my activity about diabetes and my BGs.  I also share content from ADA and IDF on this page. Here in Yazd, we created an NGO for type 1 diabetes, with the help of Yazd Diabetes Research Center, and we call it Tasnim Diabetes Association of Yazd.

Where do you get support?  Do you know many people with Type 1 diabetes?

 “Iranian Health insurance” supports my care and medical needs.

Many of my friends with type 1 diabetes are very active on social media especially on Instagram and we share a lot.  There are events and activities and even just exercise like walking in a group.  We support one another. In Yazd, I have 170 friends with type 1 diabetes.

How is access to care and access to insulin in Iran?

For essential diabetes supplies like insulin, insurance supports many people in Yazd.  Insurance covers 90% of insulin costs.  The Iranian Government has a program for people who cannot pay the cost for insurance. They are supported by Iranian Health insurance, this insurance will cover 90% of diabetes costs too, only at the government health centers, not at private health centers (non-government health centers).  Test strips and glucose meters are not covered by insurance in Iran yet.

Thank you Amir!  We greatly appreciate you sharing your voice during Ramadan.

Diabetes Voice wrote about Ramadan and diabetes in April 2019.