In the Name of Allāh,

the Entirely Merciful, the Especially Merciful

Praise is due to Allāh, Lord of the worlds, may the blessings and peace be upon our master Muḥammad, the last of prophets, on his family, and all his companions.

Resolution No. 183 (9/19) Diabetes and Fasting

The Council of the International Islamic Fiqh Academy of the Organization of the Islamic Conference, holding its 19th session in Sharjah, United Arab Emirates, on 1–5 Jumādā al-Ūlā 1430h (26–30 April 2009),

As part of the cooperation agreement signed between the Islamic Organization for Medical Sciences (IOMS) and the International Islamic Fiqh Academy (IIFA),

Following the Academy’s request to IOMS to prepare a study on Diabetes and the Fasting of Ramaḍān,

Based also on the results of the two seminars organized by IOMS on 2 Rabīʿ al-Ākhir 1429h (3 November 2007) and 8 April 2008,

Having examined the research papers submitted to the Academy concerning the continuous studies on Diabetes and Fasting,

Having listened to the discussions on the subject,

Having reviewed the medical and Fiqh aspects related to the effect of fast- ing on diabetic patients,

Resolves

First: Brief Definition of Diabetes

Diabetes is a pathological disorder in the sugar ratio in the blood, especially when this ratio surpasses the normal range. Diabetes originates from lack of the insulin hormone secreted by special cells (type B) in the pancreas; insulin insufficiency; or insufficient response of the body’s cells to insulin in some cases.

Second: Types of Diabetes

Under the title diabetes, there are different types of the disease that carry sharp differences concerning causes and methods of treatment. As per the denotations and classifications adopted by the International Medical Organization special- izing in diabetes, types of diabetes include the following:

1. Diabetes Mellitus Type I, which necessitates depending on several doses of insulin daily.

2. Diabetes Type II, which does not require depending on
3. Gestational

4. Other types including:

   1. Diabetes caused by some of the pancreas
   2. Diabetes resulting from harmonic disorders, especially in the adrenal and pituitary glands and the pancreas cells.
   3. Diabetes caused by some

Third: Medical Classification of Diabetic Patients

First Category

Patients with a very high probability to encounter severe complications for fast- ing, as medically confirmed. The sickness state of a patient of this category falls under one or more of the following cases:

• Patients who face severe hypoglycemia during the three months preceding the month of Ramaḍān.
• Patients who face repetitive ups and downs in the ratio of blood
• Patients who encounter the problem of (loss of sensation of hypoglycemia), a state which strikes some diabetic patients, especially those who are clas- sifiable under type I who face repetitive hypoglycemias for long
• Patients who are known for facing difficulty in controlling diabetes for long
• Cases of “Acidosis Diabetic Ketoacidosis” complication or (Diabetic Coma)
• Patients of diabetes type
• Patients who suffer from other severe diseases that accompany
• Diabetic patients who have to do works that require hard physical
• Diabetic patients who undergo
• Diabetes during

Second Category

This category includes patients who have relatively high probability of encoun- tering complications on fasting according to to the most-likely opinion of phy-

sicians. The sickness status of these patients falls under one or more of the fol- lowing cases:

• Those who suffer high ratio of blood sugar as when the range is 180–300 mg/ dcl (10–16.5mm) and the ratio of cumulative hemoglobin (glycated hemo- globin) exceeds 10%.
• Those who suffer renal
• Those who suffer large artery diseases (such as cardiovascular diseases).
• Those who live alone and receive medication through injection of insulin or by sugar control medicines, which reduce sugar through stimulation of the insulin producing cells in the pancreas.
• Those who suffer other diseases making them vulnerable to additional
• Old patients who suffer other
• Patients who receive medical treatments that affect the

Shariah Rulings regarding Patients in Categories I and II

Cases of these two categories are based on certainty or “supremacy of suspicion” that fasting will cause grave harm to them, as per the judgement of specilalized and trustworthy physicians. Therefore, a patient who faces any of the cases cited above for identification of patients in these two categories should not fast. It is not permissible for him to fast in order to avoid inflicting harm upon him- self. Allāh the Almighty said, «And make not your own hands contribute to your destruction,» (Al-Baqarah, 195) and He The Almighty also said, «Nor kill (or destroy) yourselves for verily Allāh hath been to you Most Merciful.» (Al-Nisāʾ, 29) The treating physicians should explain to patients of these two categories how fast- ing is risky for them and enlighten them about the high probability that they may face complications which could – most likely – be serious to their health or lives. Physicians should also do all suitable medical procedures, which could enable the patient to fast without facing harm,

Rulings that relate to non-fasting in Ramadan for sickness excuse shall ap- ply to patients in categories I and II in compliance with the directives of Allāh the Almighty Who said, «But if any of you is ill, or on a journey, the prescribed number (should be made up) from days later and for those who can do it (With hardship), is a ransom, the feeding of one that is indigent.» (Al-Baqarah, 184)

If a patient of these two categories fasts in spite of the harm, he is commit- ting a sin while his fasting is valid.

Third Category

These are patients who have the medium probability of encountering complica- tions from fasting. This category includes diabetic patients whose cases are stable and well controlled through suitable medicines that reduce sugar by stimulating the insulin producing cells in the pancreas.

Fourth Category

Patients who have low probability to encounter complications from fasting. This category includes diabetic patients whose cases are stable and well-controlled through diet only or by using medicines that reduce sugar by increasing the efficacy of the insulin in the body without stimulating the insulin-producing cells in the pancreas.

Shariah Rulings Regarding Patients in Categories III and IV

Fast-breaking during the month of Ramaḍān is not allowed for patients in these two categories since medical findings do not indicate harmful complications that could affect their health or lives. Contrarily, some of these patients could even benefit from fasting.

Physicians have to stick to these rulings and decide suitable treatment for each case separately.

Recommendations

1. Physicians are required to have a suitable degree of knowledge about Shariah rulings relating to this subject. This necessitates the preparation of such material by relevant bodies and disseminating it among those who need it.
2. Fiqh scholars and Islamic preachers are requested to advise fatwā seekers to consult physicians who know medical and religious dimensions of fasting and who fear Allāh the Almighty in providing advice on a case by case basis.
3. Due to the severity and seriousness of dangers that could originate from complications of diabetes in case fasting, and which could badly affect the health and lives of diabetic patients, guidance and information should be provided through all possible means, including sermons at mosques and through mass media, in order to enlighten patients about the rulings above; raising awareness about the disease and how it can be dealt with is essential to mitigate its effects and make it easy to accept Shariah rulings and medical advice pertaining to it.

4. IOMS, in cooperation with the Academy, should assume the task of pre- paring an information booklet on this subject in Arabic and other lan- guages and work for its dissemination among physicians and Fiqh schol- ars, and make it available online for patients to benefit thereof.
5. Calling upon ministries of health in Muslim countries to launch nation- al programs in areas of prevention, medical treatment, medication and awareness about diabetes and their Shariah rulings.

Indeed, Allāh is All-Knowing.