Being diagnosed with diabetes has not stopped a Strandfontein Muslim from fasting, which is one of the five pillars of Islam.
“I said to myself with the will of Allah I’m going to fast,” said Hajiera Safodien, 66.
“My mindset must be positive. Believe in yourself en jy vra vir Allah vir die krag,” she said.
Fasting can make it difficult for diabetics to manage blood sugar levels, and it is essential to consult a doctor in advance, to fast safely.
Diabetes is a chronic condition that causes high blood sugar levels and occurs when the body is unable to produce or effectively use insulin, a hormone that moves sugar from the bloodstream into cells to use as fuel.
Muslims fast for 29 or 30 days every year, during Ramadaan, when they abstain from food, drink and oral medications from dawn to dusk.
When Ms Safodien spoke to the Atlantic Sun recently, she had already written out a meal plan and daily routine.
Ramadaan started on Thursday May 17.
Ms Safodien, a retired nurse, had ordered snacks weeks ago to keep in the freezer and warned her family that she would do the bare minimum during the day to conserve energy.
She went “cold turkey” in terms of her diet when diagnosed with Type 1 diabetes 10 years ago after a month of fatigue. She takes two tablets a day and advocates for the daily intake of vitamin supplements.
“I had to make drastic lifestyle changes. I started walking, stopped drinking coffee because the caffeine dehydrates you, changed my diet and joined the Strandfontein diabetes support group,” she said.
Ms Safodien will take her tablets when she wakes up at 4am, two hours before dawn, when Muslims start fasting, which will be around 6am this month.
She will sip on rooibos tea and water, eat carbohydrates, including a low-glycemic index (GI) oat bran porridge, a sandwich with protein – either fish, chicken or meat – and a fruit or two.
A low-glycemic diet is one that selects foods on the basis of minimal alteration of circulating glucose levels.
“I do well with a small banana, which has potassium, no coffee because it dehydrates the body, and a date to maintain the sugar levels,” she said.
Potassium helps the body function properly, transporting nutrients into cells and helping nerves and muscles speak to each other.
“I know my body and I know what works for me,” she said.
Ms Safodien could not fast a day last year because she took strain, when her husband was admitted to hospital.
“I felt faint and dizzy. As a diabetic you know your body, you know when you don’t feel well,” she said.
She keeps some dates in her handbag in case of emergency, when on the road, but she limits her activities outside the house during Ramadaan.
“If you feel it is detrimental to your health to fast then test your blood sugar levels.
“There is no compulsion in Islam. The faith is flexible. You are not going to harm yourself or push yourself. You have to take control of your diabetes,” she said.
Ms Safodien will break her fast at sunset, now at about 6pm, with a date and a hearty bowl of vegetable soup, followed by magrib (sunset prayers) and a plate of cooked food, including a carbohydrate and protein.
Until going to bed, she will sip on rooibos tea and water, as well as nibble on fruit, cranberries, gojiberries, seeds and nuts.
She said for her Ramadaan was a good detox for the body and helped her stay away from unhealthy foods.
“I will try to minimise eating all Ramadaan koekies,” she said.
Mozaffar Ebrahim, a medical educator from a pharmaceutical company specialising in diabetes medicines and education, said all diabetics should have a blood glucose meter, test strips and lancing devices to check their blood sugar levels three times day.
Dr Aneesa Sheik, medical director of the company, said: “The lack of food and water during the day, along with the heavy meals eaten before and after fasting at suhoor and iftaar can create serious health issues for people living with diabetes, as they are faced with major disruptions to their diet and daily routines.
“This can lead to serious complications among which are low or high blood sugar levels,” she said.
Dr Sheik said a blood sugar level that is too low and left untreated can cause confusion, clumsiness, or fainting, and severe low blood sugar, can lead to seizures, coma and even death.
A high blood sugar level can damage blood vessels, and over a long period of time can result in serious complications, including irreversible organ damage. In general, fasting is very challenging for people living with diabetes, particularly patients with Type 1 diabetes, who are dependent on insulin.
“If you have Type 1 diabetes your doctor will want to ensure that the blood sugar is regularly monitored to prevent any health risks, and may even need to adjust insulin doses according to your food intake and activity,” she said.
Fasting with Type 2 diabetes can also be risky, especially if you have poorly controlled diabetes. It is important to remember that your prescribed medication may also influence your ability to fast.
“Muslims with diabetes who wish to fast must plan diligently and well in advance for a safe and healthy Ramadaan,” said Dr Sheik.