COLUMBUS — Fasting during the holy month of Ramadan is integral in the lives of Muslims, but it's not always safe for everyone to participate.

Some health-care providers may not understand the religious importance of fasting during Ramadan, which this year spans from May 5 to June 4. At the same time, some Muslim patients may be inclined to fast no matter what their doctor says.

After realizing there was a disconnect, two local doctors set out to close the gap between health-care providers and their Muslim patients by offering a series of health literacy discussions at NOOR Islamic Cultural Center in Dublin. The first discussion, in April, was on fasting with diabetes during Ramadan.

It can be hard for Muslims to hear from their doctor that they shouldn't fast, said Hassam Munir, a research fellow at the Irving, Texas-based Yaqeen Institute for Islamic Research and a Type 1 diabetic who doesn't fast during Ramadan.

"Fasting in Islam is something that's very highly regarded as almost a supreme form of worship," said Munir, who is based in Toronto, Canada. "It's a very personally enriching experience."

The idea is to stop indulging in food and drink, as people normally do, and focus their daily lives on God, what they should really be focused on, Munir said.

But sometimes people need to be reminded that "acts of worship are dependent on whether we are able to do it or not," said Dr. Sondos Al Sad, a family medicine specialist at Ohio State University's Wexner Medical Center.

There's a passage in the Qur'an, the Islamic holy book, on exceptions to fasting for Ramadan, Munir said, and if someone is ill they don't have to fast.

"God does not intend for you hardship," Munir said. "If it's going to put you in a serious medical situation with consequences, you should be able to follow the instructions of your medical professional."

Balancing fasting and diabetes can be tricky. For some, it's safe to fast with some modifications, said Dr. Luma Ghalib, a diabetes expert at Ohio State's Wexner Medical Center. For others, it's not safe at all.

"It can get a little complicated because not everyone knows the specific health concerns," she said.

Mohammad Awan, 74, of Dublin, for example, has Type 2 diabetes. He makes sure to check his blood sugar a few times a day, but hasn't had issues with fasting.

"It's pretty easy to maintain" blood-sugar levels, he said. Though Awan has noticed that his blood sugar is lower than normal when fasting, it's still been in a safe range, he said.

Diabetics can experience dehydration, spikes or drops in blood sugar, blood clotting and other problems when fasting, Ghalib said.

She recommends that diabetics who would like to fast meet with their doctors and make a plan for Ramadan. The plan should include options to stop fasting if needed, adjust medications when necessary and to keep an eye on their blood sugar levels, she said.

When they break their fast at night, Ghalib recommends they stay well-hydrated. keep their meals well-balanced, avoid simple carbohydrates and make sure to eat more than one meal. They should also continue to check their blood-sugar levels regularly.

Munir struggled for years with not fasting, and he even allowed himself to almost become comatose in order to try to fast before accepting that it wasn't safe for him.

Many people fast even after being told by their doctors not to do so, Ghalib said.

For instance, a 2001 study from the United Kingdom reported that 43% of patients surveyed with Type 1 diabetes fasted and 79% with Type 2 diabetes fasted, she said.

Munir said that may be because they want the religious experience of fasting and the socialization that comes with it.

"All Muslims are doing it around you," he said, adding that he tends to have "a feeling of missing out."

Munir now eats small meals during the day to stay healthy and avoid long-term health issues. And he tries to put his religion first in other ways, such as making sure to adhere to praying at appointed times.

He said it's also important for the friends and family of diabetics who can't fast to support them.

"This is perfectly fine. This is perfectly normal," Munir said, of not fasting. "You're not doing anything wrong, you're probably getting the same reward as everyone else because you're doing what you're told to do."