Redefining diabetes spotlight: Ramadan with diabetes - Fatima Shahzad

Last year, I had the opportunity to share my personal perspective and experience with fasting during Ramadan with type 1 diabetes. This year, we wanted to check in with other members of the community to see how they participate in Ramadan while also doing the work of an organ to manage blood sugars. This is a mini blog series that will include the perspectives of different members of the community that celebrate Ramadan in their own way - because we know there is no one size fits all approach to anything related to diabetes.

Key terms that will be used throughout this series include:

• Sehri/Suhoor - the pre-dawn meal before starting your fast.
• Iftar - the meal you break your fast with at sunset.
• Eid - a day of celebration at the end of Ramadan.
• Fidya - a religious donation of money or food to help those in need when a fast cannot be observed.

For this part of the blog series, we checked in with Fatima Shahzad, a friend of ours from the diabetes community who was diagnosed with type 1 diabetes as a teenager. We are so grateful to Fatima for sharing how she made the intention behind the month of Ramadan a priority while managing her blood glucose levels at the same time.

I was diagnosed with type 1 diabetes when I was 13 years old. If there is ever a “good” age to be diagnosed, at least I was old enough to do everything on my own and understood what was happening to my body. I was also young enough to not really remember that much of my life without type 1 - everything feels so second nature now. I do vaguely remember eating and not thinking about it or caring. I really love eating and used to eat with what now feels like reckless abandon, but that’s about it. And I do remember that I fasted before my diagnosis.

My first Ramadan with diabetes, I did fast. The days were super short and the fast only lasted until about 4:00 pm. I was also still honeymooning, which meant that I never really went low and never went over 200. And thankfully my honeymoon period seemed to last for a couple of years so I don’t remember encountering any difficulty with fasting until I was 22-23 years old when the days started to get really long. My doctors had always been super supportive, telling me to fast if I wanted while also assuring me that they were not at all nervous about it. They instilled confidence in me and in hindsight, I really appreciate that now as an adult.

Decisions related to diabetes were always mine. I don’t remember my parents playing a big role in the decision-making, just that they encouraged me in all of the new things I was learning and needing to do. They have never given me an insulin injection or checked my blood sugar, so I think that lent to their trust in my capabilities and just by nature, my dad had always been very vocal about me trusting myself and him trusting me to do the best that I can. My mom also supported that approach but I remember knowing and feeling her worry and her toeing the line between over-worrying, making me feel like she’s worried, and giving me space. I also didn’t understand that this was forever and never thought to ask for help in carrying the load because I felt good for now, until a cure in 5 to 10, maybe 15 years.

I attended an Islamic school at the time of my diagnosis, so all my peers at school were fasting and so was everyone at home. I wanted to fast because that’s what everyone else was doing. Would it have been different if I wasn’t in Islamic school? Maybe and maybe not. As I grew older, I started tracking my blood sugars and experience with fasting with diabetes in a blog but I found I was checking my blood sugars just so I could write about it.Fasting with diabetes became more about not wanting my body to dictate what I could or couldn’t do and challenging my own limits around feeling disabled or less than.

To a large extent, I lost the spiritual aspect of fasting for me as fasting with diabetes became a race against time until sunset. I kept trying to fast after hitting this point, when the days were long and the sun would set around 7:00 pm. When I first started fasting, sunset was before 5:00 pm (the lunar calendar moves back about 10 days every year). When I did try to fast during the longer days, in my early 20s, I would only break my fast if my blood glucose went below my low threshold of 65 mg/dL. One time, I was so close to iftar and had done so well all day! In a desperate attempt to keep my blood glucose above 65, I thought that maybe some stress could help—so I turned to YouTube to stress myself out by watching scary videos, thinking the adrenaline would bring my blood sugar up. Even if it was just variability in a reading, it felt like a miracle to me when I saw that 65 increase to 68!

I made it that day, but nothing about it was a spiritual experience.

After a few Ramadans like this, I gave myself more grace and was more gentle with my expectations of myself. I never felt like I had to fast from a religious perspective - I just wanted to be able to fast. I didn’t want that taken away from me. I told myself that just because I couldn’t do this one thing wasn’t a reflection of me or of my abilities. When I started grad school and moved to a new city, I made the decision to not fast during Ramadan. I knew I could if I wanted to, but making this decision felt like a weight off my shoulders. This was one less thing to worry about as I stepped into a new place, a new home, and a very busy graduate program. And it was the most liberating experience!

I was more engaged in all the other spiritual and special aspects of Ramadan and made an extra effort to go to as many iftars on campus as I could and to really celebrate Ramadan. I had the bandwidth to host and participate in community iftars, and lean into the mercy and compassion and ease that is emphasized during Ramadan, and turn that inwards. I wasn’t fasting, but I was partaking in something even bigger.

I haven’t fasted in the last 10 years ever since then. Anytime I have considered fasting and felt stressed about it, I think about how much fasting would take out of me and it reinforces the decision I have made in defining what my spirituality looks like. There are times I wish I could fast with my husband and friends, but he reminds me that I have to watch what I eat my entire life - not just during this one month which helps me contextualize the hardships that we face as people with diabetes.

As a Muslim American woman of Filipino Pakistani heritage, belonging and identity have often been things that did not come as easily.

It took a conscious effort to separate that not fasting did not make me less than in any way.

Ramadan is just one month out of the year and fasting is only one part of Ramadan. I know that a very important tenant of Ramadan is imparting Mercy - so I’ve done just that in the last 10 years, showing not only others mercy and compassion, but remembering that I deserve it as well. That, to me, is celebrating Ramadan.