Islam does not require the sick to fast, but for years and despite his doctor's order, 70-year-old Shawkat al-Khalili, a diabetic, could not get himself not to fast during the month of Ramadan, when Muslims worldwide abstain from eating food and drinking water from sunrise up to sunset.

Like al-Khalili, a retired teacher in Amman, millions of other diabetic Muslims are faced with the same dilemma per year.

Fasting is particularly more challenging for diabetics now that Ramadan already takes place in the summer. Some areas in the Mideast have temperatures exceeding 40 degrees and with lengthy daylights, diabetics are at an increased risk of dehydration and low blood sugar.

Jordan's National Center for Diabetes, Endocrinology and Genetics recommends that those with Type 1 diabetes, a condition marked by the body being unable to produce insulin, should not fast.

Many of those who have Type 2 diabetes are also advised not to fast particularly those who frequently experience sharp drops in blood sugar, those with uncontrolled sugar levels and those who already have advanced complications.

Those who fall in these conditions and still insist to fast face health risks. They can experience fainting and dizziness, or worse, suffer from stroke.

Still many devout Muslims who are sick continue to fast during the month of Ramadan especially the elderly. Such was the case of 65- year old Nayel Thnaibat, who was diagnosed in 1982 and has lost most of his sight.

"God will protect us," Thnaibat told the Associated Press. "I will not violate the fast even if I die."

Some, however, can still fast as long as they are under supervision. Adel el-Sayed, chair of the Middle East and North Africa (MENA) Region of the International Diabetes Federation (IDF) said that lately diagnosed patients who are obese may actually benefit from fasting.

Experts said that the Ramadan provides excellent opportunity for those with diabetes to lose weight if they are obese, quit smoking and achieve better control of their blood sugar.

Despite that fasting could be beneficial for some diabetics, the Saudi Diabetes and Endocrine Association (SDEA) still recommends that diabetics seek advice from their doctor before they decide to fast during the Ramadan.

The organization has issued guidelines for diabetics planning to fast during the month and these include those that cover healthy eating, nutrition, exercise, self-monitoring, medication as well as management of hyperglycemia and hypoglycemia.

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