Health officials in Birmingham have urged Muslims with diabetes to "fast safely" as the holy month of Ramadhan begins today. Fasting for Ramadhan, which runs until November 12, is one of the five pillars of Islam. People who are ill are exempt from fasting, but many diabetics opt to follow their religion, abstaining from food and fluids from dawn to sunset. Dr Felix Burden, consultant community diabetologist for Heart of Birmingham Primary Care Trust, urged any diabetic thinking of fasting to seek a medical assessment from their GP. He said it was inadvisable for those with Type 1 diabetes to fast at any time and advised any diabetic who started to feel ill during fasting to temporarily break their abstinence. "There are hazards for people with diabetes if they do not eat or drink regularly and healthily to avoid large swings in their blood glucose levels," said Dr Burden. "The major danger to those on sulphonylurea tablets or insulin is hypoglycaemia but also dehydration might occur if the patient has uncontrolled diabetes. Those diabetics who take insulin should continue to do so and should seek advice from their medical team about any appropriate adjustments which might need to be made to their dosage." He said Muslims often consumed large quantities of sugary fluids, fried foods and carbohydrate-rich meals during the hours when they were allowed to eat and drink. The morning meal of Sehri - the last opportunity to eat or drink before the fast - was often taken as early as 4am leaving a very long gap until the evening meal of Iftar, when the fast is broken. This could mean people with diabetes may experience large swings in their blood glucose levels, added Dr Burden. He issued the following advice to fasting Muslims: * Eat the meal at Sehri just before sunrise to help spread your energy intake more evenly * Limit the amount of sweet foods taken at Iftar * Have small amounts of foods such as ladoo, jelaibi or burfi but fill up on starchy foods like basmati rice, chapati or naan * Include fruits, vegetables, dhal and yoghurt in the meals both at Iftar and Sehri * Choose sugar-free types of fizzy drinks and cordials or water - avoid adding sugar to drinks and use an intense sweetener like Canderel, Sweetex or Hermesetas where needed Dr Burden added: "We thoroughly understand the wish of Muslims who are diabetic to follow their religion even though Islam permits those who are sick to refrain from fasting. "However, I do encourage those who decide they must fast to do so in a way that will not endanger their health." Diabetes is up to six times more common among Asians. | 
