Ramadan has come and gone. The long, summer days caused a great deal of apprehension for many about their ability to fast. Some searched for valid excuses that would exempt them from fasting, such as sickness or travel. But on the whole the young and the old fasted as always. Surprisingly, some diabetics in Egypt actually looked forward to fasting during Ramadan, despite their dietary restrictions. “Unlike some people who look for excuses not to fast, I actually yearn for it, so much that I get slightly upset before Ramadan,” says Nasreen al-Sharaf, who has type 1 diabetes. “My approach to fasting may not be perfect in the technical sense, but it's close enough to how normal people fast," she says. "I don't eat, I don't drink, and only in the case of hypoglycemia will I have just enough sugar to keep my blood glucose within the safe range and prevent me from harm.” There are two types of chronic diabetes, explains Aly Shinawi, an endocrinologist. Diabetes is an illness which means you have too much sugar - a vital source of energy - in your bloodstream. For people suffering from type 1 diabetes, the body does not produce insulin at all, causing a major imbalance in the blood sugar levels in the body and making an artificial regulator necessary to maintain sugar levels. Sharaf, who has been suffering from diabetes since she was three years old, says, “Fasting makes me prone to hypoglycemia, a serious diabetes complication that can lead to diabetic shock, coma or even death if not treated in time, and disrupts my insulin dosage distribution since an insulin shot has to be followed by a meal. Fasting means no meal. No meal means no insulin until iftar.” Diabetes can also cause a number of other illnesses, such as heart disease, or chest pain, heart attacks, strokes, the narrowing of arteries (atherosclerosis), and liver and kidney damage. Shinawi says a patient with diabetes or any of the aforementioned chronic illnesses should not put his or her body under the strain of fasting. Type 2 diabetes, on the other hand, is different. Type 2 diabetes means that insulin production is not strong enough in the body, or there is some resistance to it. Shinawi says fasting for type 2 diabetes is actually good because it increases the sensitivity of the cells. “Type 2 diabetes can be stabilized and cured through a change in lifestyle and eating habits. One of the risk factors of type 2 is obesity; losing about 5 to 10 percent of your weight can allow you to go without pills.” Fatma Maher got type 2 diabetes when she was 18. It started when she was pregnant the first time and then went away. With her second pregnancy three years later, it returned and has remained with her up until now, 30 years later. However, she has never stopped fasting. Maher says, “I organize my eating habits and now I take a long-lasting insulin shot once a day an hour before the sun sets, allowing my body time before I take a meal.” She says she eats slowly and only little bits at a time, allowing her body to gradually deal with the sugar. Shinawi says the long-lasting insulin also makes it easier for type 1 diabetics to fast. However, it is still important to treat an oncoming bout of hypoglycemia or extreme fatigue right away. The most mild kind of diabetes can be treated with a change in lifestyle: eating healthily, exercising regularly, or losing weight. The next kind of treatment is using drugs. Some medications, according to the American medical center the Mayo Clinic, can be used to "stimulate your pancreas to produce and release more insulin," while others "inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells" or "block the action of stomach enzymes that break down carbohydrates or make your tissues more sensitive to insulin." Another common kind of treatment is through injections, otherwise known as "insulin pens," which inject insulin into the body directly, automatically allowing it to act and not be interrupted by other stomach enzymes. The type of treatment used, the lifestyle you lead and your doctor's opinion are all very important when it comes to fasting. While Sharaf fasts based on how well her sugar levels behave, being attuned to her sugar level and on top of things makes it easier for her to cope every year. Knowing the risks fasting have on her is important to her well-being. Sharaf says, “I'm totally adapted to being diabetic, but one of the reasons I hope for a cure is so that I can fast without being hindered by the naughty 'sugar.' However, fasting is not just limited to abstaining from food or drink, it's a wider range of worship and good actions we have to acknowledge and carry out.”
