Assalamu‘alaikum. What is the ruling of injecting insulin for diabetes patients during the day in Ramadhan?
Alhamdulillah, praise and thanks to Allah for the many countless blessings He has blessed us all with. Blessings and salutations to the Prophet Muhammad PBUH, his family, companions and all those that follow his teachings to the day of judgement.
Among the things invalidate fasting is purposely inserting anything inside any open cavity of the body. Ibnu Ruslan states in his matan:
وكُـــلِّ عَـيْــنٍ وَصَــلَــتْ مُـسَـمَّــى جَـــوفٍ بِمَـنْـفَـذٍ وذِكْــــرِ صَــوْمَــا
كالـبَـطْـنِ والـدِّمَــاغِ ثـــم الـمُـثُــنِ ودُبُــــــرٍ وبـــاطِــــنٍ مِـــــــن أُذُنِ
If anything is purposely inserted into the open cavity of the body such as the nose, ear, mouth, anus, private parts of a male and female, then the fast is invalid. And it is obligatory for him to replace the invalid fast. If anything enters the body from other than the mentioned open cavities, such as the eyes and others, then the fast is still valid.
Imam al-Nawawi said: “Among the things that invalidate fasting is the insertion of anything into any open cavity of the body.” Refer Raudhah Al-Talibin Wa ‘Umdah Al-Muftin (2/356)
Answering the question asked, insulin is a type of hormone produced by the pancreas responsible in controlling the blood sugar level in our body. Diabetes is a type of sickness where the body fails to properly produce insulin, or the insulin cannot be properly utilized by the body. Insulin injections are administered to help in maintaining the blood sugar level in the body. 
Scholars have discussed the issue of injecting any type of substances inside the body during the day in Ramadhan.
- If it is a type of nutrient injection, that supply nutrients or energy, then it invalidates the fast. It is equivalent to purposely eating and drinking. This is in accordance with the hadith from Abu Hurairah RA:
مَنْ نَسِىَ وَهُوَ صَائِمٌ فَأَكَلَ أَوْ شَرِبَ فَلْيُتِمَّ صَوْمَهُ فَإِنَّمَا أَطْعَمَهُ اللَّهُ وَسَقَاهُ
“Whoever forgets that he is fasting, and eats or drinks is to complete his fast, as it was Allah who fed him and gave him something to drink.”
Sahih Muslim (2772)
Imam al-Nawawi states that the above hadith is the evidence used by most scholars. If someone eats, drinks, or have intercourse unintentionally (because he forgets that he was fasting or accidentally) during the day in Ramadhan, then it does not invalidate his fast. (Refer Al-Minhaj Syarh Sohih Muslim, 8/35). However, if it is on purpose, then the fast is invalid.
The same applies to nutrient injections during the day in Ramadhan, it invalidates the fast. This is the statement made by Imam al-Nawawi in his book al-Majmu’. (Refer Al-Majmu’ Syarh Al-Muhazzab, 6/313)
- If it is not a nutrient injection and the purpose of the injection is for medical purposes, then it is detailed as follows:
- If the medicine is injected as such that it will reach and enter the cavity. Thus, it invalidates fasting. Imam al-Nawawi: “If in the treatment of wound and the medicine enters the cavity, then it invalidates the fasting.” Refer Al-Majmu’ Syarh Al-Muhazzab(6/320)
This is the opinion of most Syafi’iyyah, Hanafiah and some scholars of madhhab Hanbali. Syeikh Mansur al-Buhuti said: “The harms (things that invalidate fasting) of fasting is rectal injection. This is an act that invalidates fasting for it results in the insertion of something into a body cavity, for it is equivalent to directly inserting something inside a human cavity. The same is applicable where the fast is invalid if the treatment is through a mean where the medicine will reach and enter a human cavity. The reason is treatment is a choice of a person.” Refer Kassyaf Al-Qina’ ‘an Matn Al-Iqna’ (2/318)
- If it is injected through body muscles or other parts of the body such as the thigh or arm, then it does not invalidate fast. (Refer Al-Taqrirat Al-Sadidah Qism Al-‘Ibadah, pg. 452) This is also the decision made in the discussion of Majma’ al-Fiqh al-Islami which convened in Saudi Arabia from 28th June until 3rd July 1997.
To conclude, we would like to state that if the injection is a nutritional injection that gives energy, then it invalidates fast. Likewise, the fast is also invalidated if it is injected through veins or parts that reach the cavity. However, if it is injected through other body parts such as the thigh or arm, then it does not invalidate the fast.
We advise that the insulin is not injected at the stomach or buttocks. These two areas are close and connected to the cavity. However, it should be reminded that the side effect of insulin injection is hypoglycaemia, which decreases the sugar levels in a patient’s body which could weaken him. In this situation, the patient is given a choice of breaking his fast and replacing it later. This is in accordance with the statement of Allah SWT:
أَيَّامًا مَّعْدُودَٰتٍ ۚ فَمَن كَانَ مِنكُم مَّرِيضًا أَوْ عَلَىٰ سَفَرٍ فَعِدَّةٌ مِّنْ أَيَّامٍ أُخَرَ ۚ
“[Fasting for] a limited number of days. So, whoever among you is ill or on a journey [during them] - then an equal number of days [are to be made up].”
Surah al-Baqarah (184)
We recommend diabetics such as the questioner to refer to a medical expert and get the advice on the correct and appropriate way of performing the insulin injection as to benefit from it without resulting or causing any harm.
We end with a supplication to Allah SWT so that all of us are granted with health:
اللَّهُمَّ اشْفِ مَرْضَانَا وَعَافِ مُبْتَلَانَا وَارْحَمْ مَوْتَانَا
“O Allah! Heal those who are sick among us. Remove the difficulty for those who are tested and bless those who have passed away from among us.”