Endocrine Abstracts

Introduction: Fasting during the holy month of Ramadan is one of the five pillars of Islam. It requires abstaining from all food and drink from dawn until dusk. While exemptions are granted to those with medical conditions such as diabetes, many Muslim children and young people (CYP) with diabetes still choose to fast. Without appropriate guidance and awareness of both medical considerations and religious rulings, fasting can be challenging. We collected evidence from Islamic literature to support Muslim CYP with type 1 diabetes in deciding about fasting and also to provide some guidance about fasting while on hybrid closed-loop systems (HCL) or Multiple daily injections (MDI). Micro-teaching in the clinic waiting area is a local initiative that has been implemented for years as part of our diabetes team’s quality improvement. This was seen as a good opportunity to provide education and counselling about fasting before the start of Ramadan.

Methods: Islamic literature was collated to provide evidence on key rulings regarding fasting and insulin treatment. A review of the literature on fasting Ramadan in children and young people with diabetes was also conducted to determine best practices. Proposed guidance on blood sugar cut-offs to break the fast was compiled and presented to the wider Diabetes MDT for feedback.

Results: Guidance from the Holy Quran and Islamic resources were reviewed to provide clarity on three key areas:

1. Religious allowances for the sick to abstain from fasting

2. The Islamic view on adherence to medical advice

3. Confirmation that insulin administration and blood glucose monitoring do not invalidate the fast Cut-off values for when to break the fast if fasting was started, as well as further management regarding hypoglycaemia and hyperglycaemia, were added to create a resource about fasting as micro-teaching slides. A leaflet was also designed for take-home messages.

Further Work: CYP who fasted last Ramadan and their families will be surveyed about their perceptions of the slides and leaflets, and asked to participate in a pre- and post-quiz on the slides to assess the improvement in their knowledge.