Hypoglycemia and Ramadan

Hanafi Fiqh

Answered by Dr. Asim Yusuf
Question: As-salaamu Alaykum,
I am hypoglycemic. The past few years I have fasted Ramadan but I wasn’t work during Ramadan. This year I will be an intense work during Ramadan which has made me concerned. I have noticed that I can get dangerously dizzy and can “black out.” I am also taking medication.
I do not want to miss out on fasting but I am concerned about my condition.
Can you help me?
Answer: I pray this finds you well and that Allah bestow upon you and your family relief from illness and a great reward for patiently bearing through it. The answer to your question, as with many who have similar questions, is: it depends. For a general understanding of the fundamentally merciful nature of the Sharia and the inter-linkage of expert opinion and religious law, I would refer you to this article.
Nonetheless, it is a well-known fact that Allah does not impose undue burdens on His creation, and that even in the most ultimately important of all affairs – the establishment of a relationship between Creator and creation through worship – allowance is made in situations where strict performance of the act might lead to undue hardship. This is most manifest in the ordination of the fast: Allah says, ‘whomsoever among you witnesses [the month of Ramadan] must fast; but if one of you is sick or on a journey, let them complete it on other days. Allah does not desire that hardship come to you, but rather ease…’
Whether a particular illness fulfils the requirements for an excuse that would lift the obligation to fast during Ramadan is a highly individual question which depends on the person, the condition and the circumstance. It ultimately boils down to whether the likely consequences of fasting would be significantly detrimental. There are a number of answers to similar questions to be found on the Seeker’s Guidance Answers section, and there is a good discussion of what might be called the ‘fiqh of reasonable fear’ to be found here. As an appendix to that answer, a few points should be noted:
1.In terms of determining what the potential consequences of fasting might be, three options are given. Of these, it is clear that, in our time, the most reliable is expert opinion (usually medical or other allied health professional). Health professionals are plentiful, specialised, highly trained and closely regulated; there are protocols of diagnosis and management widely available to them and which are all but obligatory for them to follow. Thus the guidance on health that one receives from them is often not merely the subjective opinion of a competent professional, but the relaying of the collective wisdom of hundreds of experts (much like a madhab, in fact!).
2.It should equally be noted, as a counter-balance to that, that medical professionals are normally not sufficiently trained (if at all) in the issuing of Islamic verdicts. They would not be aware of the limits of the Sharia, the spiritual importance of the fast (not just as an act of worship but as a nurturing of the soul), and the manners of determining when a condition might exempt one from fasting.
a.As an example of this, my wife once asked a Specialist Muslim OBGYN whether a pregnant woman should fast, and received a straight answer: ‘no.’ She then asked, ‘under what circumstances might an otherwise healthy pregnant woman abstaining from food and drink for 14-16 hours – but nourishing herself well outside of these times – be detrimental to mother or foetus, and in what way?’ The specialist went away, researched the question, and then came back with a nuanced, referenced and well-supported medical answer with no reference to any sort of legal verdict. (The short answer, out of interest, was ‘there are very few circumstances.’)
3.This is the ideal way to balance between fiqh and science: let the experts in each field pronounce on the basis of their own expertise and not go beyond it. Islamic scholars are not medical experts, and medical experts are not scholars; each is in need of the other to arrive at a sound ruling. Ghazali said, ‘when a thing exceeds its limits, it becomes its own opposite.’
In terms of your question, it would be difficult (and dangerous) for me to comment any further without knowing more specifics than you have provided (or possibly even know yourself). Hypoglycaemia (low blood sugar) is a dangerous condition with potentially life-threatening consequences. However, it is remediable through careful diet, prolonged-release sugars and – where required – medication. Given your commendable desire to keep the fast, I would advise that you seek out a physician, determine a clear diagnosis, level of severity and prognosis, and undertake treatment. There are many people who are diabetic, for example, but are able to keep even long Ramadan fasts through careful management of their conditions, regular monitoring, and guided modification of their treatment plans. Additionally, many commence fasting each day but break their fast if they feel symptoms of hypoglycaemia or detect it on blood monitoring, making up those fasts on shorter or cooler days.
On the other hand, many people adopt a cavalier approach to fasting despite their serious medical conditions, and cause themselves either short or long-term harm through a misplaced ‘trust in God.’ As the beloved Prophet (peace and blessings on him and his family) explained, ‘tie your camel (ie: take necessary precautions first) and then place your trust in God!’ I remember my father and I pleading with my 80 year old grandmother not to fast because of her medical conditions, explaining that Allah would reward her for her intention to fast and for her acceptance of His dispensation!
The same applies to any other medications that you may be taking. Most (but not all) long-term medications need to be taken at regular intervals to maintain what is known as a ‘steady-state equilibrium’ in the bloodstream – effectively a balance between intake and output. Modifying the dosing regimen – under expert supervision – is not normally problematic. Medications that should be taken, for example, at 8am and 8pm can normally be adjusted to fit around the fast. Thrice-daily medications can often be altered to twice-daily regimens in the same way. However, this should be done after taking advice from a professional – for it does not apply to all medications.
In summary, speak to your physician, ask them questions about consequence and modifiers that are within their expertise, and then discuss their opinions with a reliable and wise local scholar. There are vast amounts of information and protocols for the management of diabetic patients during Ramadan freely available online, for example: Recommendations for Management of Diabetes During Ramadan. Feel free to take these along to your physician to help them in their decision-making process. Indeed, whether you intend to fast or not, the fact of your family history and that you black-out at times is sufficient reason to visit your doctor. It is our duty –and a fundamental part of our trust and faith in God – to seek the means to wellness (‘afiya) in this world and the next.
Ultimately, Allah decrees that your health comes first, but do not miss an opportunity to worship him if you can avoid it. I pray that these words are of some small benefit, and ask that you do not forget me, my family, my teachers and all believers in your duas during this and other blessed times.
Was salam
Checked & Approved by Faraz Rabbani
Dr. Asim Yusuf is a teacher, author vocalist and medical doctor. He was born in London and grew up in Manchester, before emigrating to South Africa with his family for a ten year stay. He has been studying the sacred sciences for many years with many notable scholars including Al-Allama Rasool Bakhsh Saeedi, Shaykh Muhammad al-Yaqoubi amongst others. He is the academic director of the Path to Salvation (www.pathtosalvation.co.uk), an integrative modular syllabus of Islamic studies. He has been authorized to instruct students in a number of Islamic sciences, and currently teaches theology, jurisprudence, spirituality, tafsir and hadith. Dr. Asim is also a member of the Royal College of Psychiatrists and is currently pursuing his Masters in Medical Education.