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Manzur Bhinder is photographed in his Mississauga home on March 21, 2018.Fred Lum

Manzur Bhinder hasn’t missed a fast during Ramadan in the past 50 years. But his annual ritual after being diagnosed with diabetes 35 years ago has also included visits to his endocrinologist to adjust his medication.

“God asked me to fast so I said okay,” says Mr. Bhinder, 78. “When you believe in something, it makes it easier.”

Mr. Bhinder lives in the city of Mississauga in the Peel region, an area with an exceptionally high rate of diabetes. Approximately one in seven of Peel residents have diabetes, partly due to low walkability and environmental factors and also the region’s large South Asian population. (Research has found that South Asians are at higher risk of developing diabetes than the general population.)

That is the driving reason behind this week’s release of new guidelines aimed at keeping people healthy when Ramadan begins in May.

The Canadian Ramadan Position Statement was produced by the Peel-based STOP Diabetes Foundation Inc. and Diabetes Canada, in an effort to educate health-care practitioners and the public about how to manage the disease during the month of celebration that involves fasting during the daylight hours from dawn to sunset.

“Canada being a multicultural society, which we are all proud of, I think that it’s high time we came up with this,” says Dr. Harpreet Bajaj, endocrinologist and founder of STOP Diabetes Foundation, based in Brampton, Ont.

Diabetes is a disease in which the body either cannot produce insulin — the hormone that controls the amount of glucose in the blood — or cannot properly use the insulin it produces.

Fasting when you’re on medication during the summer months in Canada often involves long hours, which can cause a person’s glucose levels to fluctuate. This can result in low blood sugar or dehydration, Dr. Bajaj says.

During Ramadan, people are fasting through the day but eating a lot of sweets, sugary drinks and fried foods at night, which are all increasing their risk of developing diabetes, Dr. Bajaj says.

The new statement includes instructions on medication adjustments, changes in insulin doses and testing glucose levels for the month of Ramadan.

Dr. Bajaj says some pills and insulin doses have a higher risk of causing low sugar reactions or dehydration so certain people require a change or reduction in medication. The statement provides suggestions around changing the doses of insulin or type of insulin to a safer combination to prevent that from happening.

It suggests that people with diabetes get assessed by a health-care provider to see if it is safe for them to fast, and also test their insulin levels four to five times a day before the fasting period to make sure their sugar levels aren’t low.

Dr. Bajaj says their plan is to have the statement submitted for publication in the Canadian Journal of Diabetes before Ramadan starts in May.

According to Dr. Jessica Hopkins, Peel’s Regional Officer of Health, the total number of diabetes cases in the Peel region went up from 11,500 per 100,000 population in 2005 to 15,700 in 2015.

“The causes of Type 2 diabetes are genetic, environmental and behavioural, and Peel has problems in all three areas,” says Dr. Jan Hux, president of Diabetes Canada.

Dr. Hux says that Peel is home to a large South Asian population and there is a high genetic risk of having diabetes in that community.

In addition, she says that Peel’s suburban environment requires people to get in their car to do just about anything and makes it harder to stay active. It’s also much further to go to get high-quality fruits and vegetables. These factors work together to increase the risk of diabetes.

Dr. Hux added that there has been a shift in diabetes toward younger ages and women in their childbearing years.

“We used to think of Type 2 diabetes never occurring in children and yet we’re seeing increasing numbers of cases of Type 2 diabetes in young people and children where there is a high genetic risk,” she says.

Dr. Hux says that the rate of diabetes is growing rapidly not just in the Peel region but across the general population.

“We know that the number of Ontarians with diabetes has doubled in the last 12 years and that growth continues. Another Canadian is diagnosed every three minutes,” Dr. Hux says. “It’s urgent for people and health-care [providers] and municipality governments to get serious about prevention.”

As for Mr. Bhinder, he is looking forward to taking part in the prayers of Ramadan, but will have to be very careful with what he eats during the night by taking breaks and eating in moderation.