For most of Australia's 496,000 Muslims, the start of Ramadan today is a holy month of fasting by day and feasting by night. But for the about 22,000 Australian Muslims with diabetes, it can be a time of fluctuations in blood sugar levels that can be dangerous, even deadly.

''I've seen people die one or two minutes before the fast is ending,'' said a visiting endocrinologist from Saudi Arabia, Dr Al Saeed.

''They developed hypoglycemia but refused to break their fast. They became unconscious and died.''

The Koran exempts those who are sick or suffer from a chronic condition, such as diabetes, from fasting. Yet 43 per cent of people with type 1 diabetes and 79 per cent of patients with type 2 diabetes fasted through Ramadan, the Diabetes Journal reported.

During Ramadan last year, Ms Hajeh broke her fast once when she started to feel dizzy. Before fasting, she sought medical advice on how to manage her diabetes. But her parents, who live in Tripoli, Lebanon, insisted on fasting every year, even though it made their diabetes worse.

An equally big issue is the huge increase in blood sugar when people break their fast.