Does taking an injection break the fast? I am a diabetic patient and I take insulin daily — can I take insulin in Ramadan while in the state of fasting? What is the ruling on a drip (saline and glucose) and a blood test? What is the Shariah guidance for patients in Ramadan?

The fast is broken by that which enters the body as food or as its substitute. Majma' Al-Fiqh Al-Islami (Islamic Fiqh Academy, Jeddah), in its tenth session (Jeddah, 23–28 Safar 1418 AH / 1997), in its Resolution No. 93 (1/10), has given a clear decision that injections given under the skin, into the muscle or into a vein do not break the fast, however nutritive fluid and serum (drip) are excepted from this. All detail is arranged on this same principle.

Those injections which are not nutritive but therapeutic — insulin, penicillin and other antibiotics, pain-relieving medicines and vaccines — the fast is not broken by them, whether they are given into the muscle or into a vein. The fatwa of Shaykh Muhammad ibn Ibrahim, may Allah have mercy on him, is that penicillin and insulin injections do not affect the fast, whether they are given into the muscle or into a vein, however precaution is that they be given at night (Fatawa Ash-Shaykh Muhammad ibn Ibrahim: 4/189). Therefore, diabetic patients can take insulin in the state of fasting; where it is medically possible, keeping the times around sahur and iftar is better and closer to precaution.

A drip or injection which provides the body with food and energy — glucose, nutritive serum and solutions given into a vein — is in the ruling of eating and drinking and the fast is broken by it. Shaykh Ibn Uthaymin, may Allah have mercy on him, said that nutritive needles have the ruling of food, because they are a substitute for eating and drinking (Majalis Shahr Ramadan, p. 70), and a drip of salty solution (saline) has also been included in this same nutritive category. Therefore, an unnecessary drip should not be taken during the day in Ramadan; if needed, it should be taken at night, otherwise making up (qada) that day's fast will become necessary.

According to the fatwa of Al-Lajnah Ad-Da'imah, the fast is broken by kidney dialysis (Fatawa Al-Lajnah Ad-Da'imah: 10/19), because in this process, along with cleaning of the blood, solutions and substances also enter the body; such patients should benefit from the concession which is mentioned ahead. The fast is not broken by the small amount of blood taken for a routine blood test — this is the investigation of both Shaykh Ibn Baz, may Allah have mercy on him (Majmu' Fatawa: 15/274), and Shaykh Ibn Uthaymin, may Allah have mercy on him (Fatawa Arkan Al-Islam, p. 478). However, if blood is taken out in a large amount, to the extent of a donation, the fast will be broken, by analogy with cupping (hijamah), because the Messenger of Allah ﷺ said: “The one who performs cupping and the one on whom cupping is performed, both have broken their fast” (Sunan Abi Dawud: 2367; Sunan Ibn Majah: 1679; sahih according to Al-Albani, may Allah have mercy on him) — it should be clear that regarding cupping being a breaker of the fast there has been a difference among the early majority, but an amount equal to a donation should, as a precaution, not be taken out during the day.

Allah Almighty has given the patient a concession: ﴿فَمَن كَانَ مِنكُم مَّرِيضًا أَوْ عَلَىٰ سَفَرٍ فَعِدَّةٌ مِّنْ أَيَّامٍ أُخَرَ﴾ (So whoever among you is ill or on a journey [during Ramadan], then [he shall fast] an equal number of other days) (Surah Al-Baqarah: 184), and He said: ﴿يُرِيدُ اللَّهُ بِكُمُ الْيُسْرَ وَلَا يُرِيدُ بِكُمُ الْعُسْرَ﴾ (Allah intends for you ease and does not intend for you hardship) (Surah Al-Baqarah: 185). In a temporary illness, there is making up (qada) of the missed days, and whoever, due to a chronic illness, does not have the capacity even for qada, shall feed one poor person for each fast (fidyah). Patients with diabetes, etc., should consult their physician and shift the times of medicines and insulin to the night, and where fasting is genuinely dangerous for health, they should never throw themselves into destruction there; acting upon the concession is also obedience to Allah Himself.

Maqasid note: The objective of fasting is taqwa, not destruction of life. Preservation of life (hifz al-nafs) is among the great objectives of the Shariah; for this very reason, the Shariah, by giving the patient a concession, has protected both worship and health.

Translated from the original Urdu fatwa.