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Jamea Masjid

Jamea Masjid. Mohammed Patel – Specialist Pharmacist Dr A. Dasu – Local GP Dr I. Patel – GPST3 Dr N. Desai – FY1 Sr Rehana – Diabetes Nurse Specialist. British Islamic Medical Association. Volunteer led and delivered Presence in all regions across the UK

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Jamea Masjid

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  1. Jamea Masjid Mohammed Patel – Specialist Pharmacist Dr A. Dasu – Local GP Dr I. Patel – GPST3 Dr N. Desai – FY1 SrRehana – Diabetes Nurse Specialist

  2. British Islamic Medical Association • Volunteer led and delivered • Presence in all regions across the UK • Strong Islamic values and community links • Network of Health Care Professionals 2000+ members who are Doctors, Pharmacists, Dietitians, Dentists, Optometrists, Nurses, Paramedics, Students and more..

  3. BIMA Mission Inspire our members to unite in the service of our patients and profession

  4. DISCLAIMER This BIMA Health Promotion presentation is intended to provide general information to the public, and is not intended to address specific circumstances of any particular individual or entity and does not replace independent professional guidance and judgements.  BIMA has no conflicts of interest in this presentation and have independently compiled this presentation. We have received no sponsorship from pharmaceutical companies or Islamic organisations. All reasonable measures have been taken to ensure the quality and accuracy of the information presented in this talk. If you find any information regarding this talk that you believe may be inaccurate, please email BIMA at healthpromotion@britishima.org or speak to the presenter.

  5. IMPORTANT • Please consult your GP for your specific medical needs • Please consult a scholar with regards to any specific Islamic rulings related to fasting • There are differences of opinion within Islamic Jurisprudence and scholars and we respect these

  6. AIMS • Learn about health benefits and risks of fasting • Managing health conditions especially Diabetes when fasting • Discuss a healthy diet plan with examples from ‘healthier’ cuisine from different ethnicities • Advise on exercise, weight management and smoking

  7. Why we fast

  8. Why we fast • Command from Allah SWT as compulsory in Ramadan unless exempted O you who believe! fasting is prescribed for you, as it was prescribed for those before you, that you may become righteous (Surah Baqarah, Ayah 183) • Health benefits are secondary • Recommended voluntary fasts • Shawwal ( 6 days ), Dhul Hijjah ( first 9 days before Eid), Muharram ( 10th ) ,Rajab, Sha`ban,…. • 13th,14th,15th days of any Islamic month • Monday & Thursday Sunnah • Alternate days (Prophet Dawud)

  9. Health Benefits of Fasting

  10. Health Benefits of Fasting • Weight loss - if done correctly • Improvement in Cholesterol • Improvement in Blood Pressure control • Blood Glucose Control (in majority) • Mental well being • Control of habits/ addictions e.g. smoking/ unhealthy snacking • Intermittent fasting/Short periods of fasting – Evidence that it is beneficial for all of the above if properly controlled

  11. Each year smoking causes the greatest number of preventable deaths HIV: 529 Alcohol: 8,724 Traffic: 2,946 Obesity: 34,000 Smoking: 81,400 Murder:648 Suicide: 5,377 • Abstaining from smoking in Ramadan is an ideal opportunity to kick the habit

  12. Health Risks of Fasting

  13. Health Risks of Fasting Potential & Can be serious

  14. Potential Health Risks of Fasting • Dehydration • Stress • Sleep disruption • Worsening of medical condition Various health related complications if certain patients/individuals insist to fast despite approved religious and/or medical exemptions

  15. At risk groups • Diabetes • Asthma/COPD • Chronic Heart Failure • Chronic Kidney Disease • Mental Health (Schizophrenia/Bipolar) • Glaucoma • Infections (acute & chronic) • Pregnancy/Breast-feeding

  16. Impact of fasting on the body

  17. Medical exemptions in Ramadan • Patients with certain conditions are exempt from fasting during Ramadan • High risk of complications if daily food and fluid intake are markedly altered • More than a permission not to fast • Quran specifically exempts people who are ill from fasting • ‘Fidyah’: compensation for not fasting • Fast at later date (following recovery of acute illnesses) • Feed the hungry and poor (for exemptions due to chronic illnesses)

  18. To fast or not to fast? Person Religion Medicine • The decision to fast during Ramadan is based on important considerations, including: • The decision of the individual • Religious opinion • Medical opinion Many Muslims with exemptions and health conditions insist on fasting during Ramadan. This creates a medical challenge for both patients and physicians. Al-Arouj M, et al. Diabetes Care. 2010; 33(8):1895–1902.

  19. Diabetes and Fasting

  20. Potential risks in diabetics Hypoglycaemia NOT all diabetics affected- only those on certain medication and insulin Dehydration • Dry mouth/lips/skin • Urinating less • Excessively thirsty Hyperglycaemia Headaches/Tiredness Frequent urination ‘Pear-drop smell on breath’

  21. Suggested action plan • Visit your doctor/diabetic nurse/pharmacist (ideally two months prior to Ramadan) • If you are advised by a health professional to not fast, then you should take the advice. • If you are unable to fast, speak to your scholar. • It may be a good idea to fast a few days in the month before Ramadan (Shabaan) to see if you can complete it without any problems. I never saw the Messenger of Allah (saws) fast for an entire month except in Ramadan and I never saw him fast more than he did in Shabaan. (Bukhari and Muslim)

  22. How should I manage my diabetes? • Take medication with your food • Follow individualized medication plan (as devised with your doctor or health care professional). • For all exercise regimes consult your HCP, to ensure good blood glucose control. Make not your own hands contribute to your destruction. (Surah Baqarah, Ayah 195)

  23. Blood glucose control • If you have a blood glucose meter it is important that you check your blood glucose levels more often during fasting. • Good glucose control helps reduce your risk of developing future complications such as: • Blindness • Heart disease • Stroke • Nerve damage • Kidney disease.

  24. When to end the fast • If your blood glucose is less than 3.9 mmol/l, end the fast immediately and treat the low blood sugar level. • If your blood glucose level is higher than 16.7mmol/l • If you become dehydrated • You should never stop your insulin, but you must speak to your doctor because you may need to change the type, dose and times of your insulin injections.

  25. Guidance on Medication Taking in Diabetes LOW RISK: Well controlled May just need to change timing of medication MODERATE RISK • Poor controlled (complications) • Insulin treated Type 2 diabetes Must discuss plan and agree with diabetics team first • HIGH RISK • Persistent poor controlled (renal failure) • Type 1 diabetes • Recent hospital admission due to hypo SHOULD NOT FAST

  26. DO NOT STOP using eye drops • Stopping glaucoma drops for even a short period of time can cause permanent loss of vision. • The International Glaucoma Association, with the MCB, advises: • Do not stop eye drops during Ramadan – majority of Islamic Schools of thought support this • If you are still doubtful, use morning drops at Suhoor and evening drops at Iftar • To stop the drop reaching the back of your throat: try practicing punctal occlusion: put finger pressure at the corner of the eye next to the nose immediately after instilling drops • For more information, contact the IGA’s helpline, Sightline: 01233 64 81 70 • sightline@iga.org.uk • www.glaucoma-association.cozzm

  27. Take home messages (Diabetics) • Talk to your diabetes team before you start fasting • Test your blood glucose regularly • Look for signs of hypoglycaemia, hyperglycaemia and dehydration • Make sure someone you know is aware you are fasting • Always carry some glucose tablets, glucose gel or a sugary drink in case of hypo. This should be followed up with a snack. • Finally if you are ill – break your fast!

  28. General recommendations for patients observing fast • Maintain normal levels of physical activity • Avoid excessive physical activity especially before sunset meal • Prayer activities should be considered part of the exercise program • Maintain a healthy and balanced diet • Avoid fats during sunset meal • Increased fluid intake during non-fasting hours • With a health or medical condition seek tailored nutritional advise • Aim to maintain weight Nutrition Exercise • Care must be highly individualised • Frequent blood glucosemonitoring is essential Break fast Individualisation • Always and immediately end fast when blood glucose <70 mg/dL (4 mmol/L) in the first hours after the start of the fast or anytime if its above 300 mg/dL (16.7 mmol/L) SMBG, self-measured blood glucose Al-Arouj M, et al. Diabetes Care 2010;33:1895-902

  29. Physical Activity During Ramadan regular light and moderate exercise is safe, Avoid rigorous exercise, Watch for dehydration and hypoglycaemia

  30. Eat of the good wholesome things. (Surah Ta-Ha, Ayah 81)

  31. Suhoor • Wholesome (e.g. non-processed, ethical etc) and balanced (include some food from different food groups on the eat well plate) 2. A moderate size correct portion sizes, avoid overeating and bowel discomfort. 3. Fiber rich and slowly digesting (low GI foods)  that provide longer lasting energy for many hours and helps to avoid constipation 4. Plenty of fluids. 5. Take Suhoor as late as possible ( Sunnah ).

  32. Water, Milk and Yoghurt drinks are good fluid optionsFluid-rich foods, such as fruit (watermelon), vegetables, soups and stews can also help increase your fluid intake. How can I get my 200ml in?

  33. Example of High Fibre and Complex Carb containing foods: Complex carb High Fibre

  34. Iftar • 1 date and glass of milk or water , followed by Maghrib. • Light healthy balanced meal. • High fibre foods & complex carbs • Water, Water, Water

  35. Healthier Options • Cut down on deep fried foods - can contribute to indigestion and heart burn. • Try grilled, baked, steamed or dry fried foods instead. • Choose fruit and vegetables as snacks over foods high in fat, sugar and salt. (Not only they provide vitamin and minerals but also improve your fiber and fluid intake). • Avoid sugary, fizzy and caffeinated drinks - They make you more thirsty. • Coffee drinkers - Try reducing your coffee intake over the weeks leading up to Ramadan to help ease you in.

  36. Suggested meal ideas

  37. Oral Hygiene: advice • Brush and floss teeth twice daily: before sleeping at night and after Suhoor • Bad breath: tongue brush/ scraper or use mouthwash outside or during of fasting hours. Don’t forget your miswak! • Avoid fizzy or acidic drinks; rinse mouth with water

  38. Take home messages (for all) • Benefits: Weight loss, Improvement in: Cholesterol, Blood Pressure control, control/reduction in habits & addictions e.g. like smoking, excessive caffeine use • Remember complex carbs, fibre & fluids • Light and moderate exercise • Speak to your medical experts and scholars for any concerns ‘Eat and drink, but not excessively’ (Surah 7 v31) Have a clever Ramadan Diet Plan

  39. Diabetes & Fasting Recommendationsfor patients • Patient information leaflet • Based on MCB ( Muslim Council of Britain ) and Diabetes Professional Advisory Group (Diabetes UK ) . • Based on consensus of expert opinion.

  40. With thanks to.. • MCB • Diabetes UK • International Glaucoma Association • Dr Ahmed Helmy (Consultant Endocrinologist) • Dr Muhammad Ali Karamat (Consultant Endocrinologist) • Dr Ateeq Syed (Consultant Endocrinologist) All based at University Hospitals Birmingham NHS Trust • HibahIlyas(Specialist Diabetes Dietician) • Najiya Rahman (Community Nutritionist)

  41. THANK YOUMay you all have a blessed and productive Ramadan Any Questions?

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