Although some Muslim patients are excused for health reasons, many want to fast during Ramadan, including those with diabetes. The importance of monitoring blood sugars regularly should be enforced, especially if fasting patients take insulin. Pre-dawn and post-evening meals should be tailored, for example including carbohydrates that release energy slowly in the pre-dawn meal. The importance of “breaking the fast” should be emphasised if blood glucose levels fall, placing the individual at risk of a hypoglycaemic condition. Symptoms include feeling shaky, sweaty and disorientated. Some patients with type 1 diabetes may also experience hyperglycaemia and ketoacidosis in response to fasting (Diabetes UK, 2015). Diabetes UK offers information and advice for people with diabetes who plan to fast during Ramadan.
A pre-fasting diabetes assessment is recommended so patients can be made aware of individual risks and strategies to minimise them, or even advised to refrain from full observance due to their health status. It is important for diabetes nurses to provide fasting-focused diabetes education to those with diabetes, given that structured education is well established in the management of diabetes (Hassanein, 2010).
While medications to treat the sick are permissible, it is forbidden (haram) to use prohibited products that are alcohol, gelatine or pork based. It may be possible to obtain gelatine-free alternatives such as antibiotic liquids, or capsules containing halal gelatine. Magnesium stearate (stearic acid) is used as an active ingredient in some tablets – this is forbidden when derived from an animal source. In emergencies, this rule does not apply if an alternate drug is not available, but this should be explained to the patient. If the medication is absolutely necessary, Islam permits its use. A practical way of ensuring health professionals have enough information would be for the British National Formulary or other alternative to clearly indicate which preparations contain blood, animal and alcohol derivatives, and, where possible, suggest suitable alternatives (Gatrad et al, 2005).
The left hand is considered unclean in many Muslim cultures. To avoid offence, the following should be done using the right hand: “Feeding Medicine administration” Handing items to patients.
Caring for Muslim patients involves meeting their needs in the context of their own culture and beliefs. Islam does not only provide guidance in spiritual matters but also places considerable emphasis on health and prevention. Several Islamic beliefs will affect Muslim patients’ attitudes and behaviour in hospital and com-munity settings; it is important for nurses to have some understanding of these so they can offer culturally appropriate care. It is important to be aware that the preservation of life overrides all of the guidelines; in emergency or life-threatening situations, there are no restrictions of any kind on medication, treatment or preventative or nursing interventions. Muslims believe that cure comes solely from Allah, even if this is delivered via a health professional. When caring for a Muslim patient it is important to understand why certain acts are carried out, and why adherence or non-adherence to treatment may occur.
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