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Islam is the second largest religion in Britain, after Christianity. In 2001, the number of Muslims in Britain was around 2.5 million. Devoted healthy Muslims commemorate the revelation of the Holy Quran by Allah to the Prophet Mohammed by fasting in the month of Ramadan every year. Ramadan lasts for 29 or 30 days, depending on the sighting of the moon. While continuing their daily occupation without time off, fasting Muslims abstain from food, liquids, tobacco, sexual activity and medication (oral, inhaler or injection) from sunrise to sunset. However, the sick, the pregnant and nursing mothers and children are exempt; moreover, if a fasting person becomes ill, he or she is allowed to end the fast in the day.
Ramadan directly influences the control of diabetes because of the month-long changes in meal times, types of foods, use of medication and daily lifestyle1,2. Doctors and nurses who encounter Muslim diabetic patients need to understand the practicalities. What does a controlled diabetic Muslim do in Ramadan that a health professional should know about?
The religious goal of enhancing physical, psychological, social and spiritual wellbeing is achieved by the following daily customs.
In Ramadan a Muslim fasts from dawn to dusk and ends the fast with dates (or prunes if dates are not available) and water or juice.
Iftari, a big evening meal with extra sweet and savoury foods, but still a balanced diet, is taken after the sunset prayer.
Men walk to the local mosque for night prayer whilst most women pray at home (for reasons of safety).
Sehri, a light meal is taken before sunrise. Some Muslims omit this meal so as not to disturb their non-Muslim neighbours. This may contribute to hypoglycaemia during the day.
Prayer and meditation—which are akin to group therapy—result in self-audit and relaxation.
Religious leaders, elders and colleagues of the same sex provide counselling.
Friends and relatives are invited to iftari, making it a feast and social event.
Sick friends and relatives are visited, with sharing of the care as appropriate.
Taraveeh is a special night prayer: standing in the mosque the Muslim listens to the Holy Quran. A hafiz (who has the Holy Quran by heart) recites all 30 chapters of the Holy Quran through the month.
There is extra listening to sermons, and the Muslim becomes more pious and sensitive; he or she feels more guilty if a religious taboo is broken, even by medication. This guilt may be accompanied by self-disgust and spiritual pain—very unpleasant.
A Muslim may be devoted, liberal or secular; assess carefully how religiously devoted your patient is. Health professionals are also human and may have negative feelings about Muslims. Referral to another doctor will sometimes help both parties; take it or leave it, but do not proceed half-heartedly. Communication with the patient begins with respecting names. Even if they do not show it, many will be upset if you write Muslim as Moslem and Quran as Koran, if you use initials instead of full first and middle names (because these have religious connotations) and if you ask ‘what is your Christian name?’. These cultural issues, and the minutiae of diabetes management, have been discussed elsewhere3,4,5. Here are ten practical points.
I hope that general practices and hospital clinics will use these notes as a starting point for drawing up guidelines according to local needs and circumstances.